Suicidal Feelings – Still a Taboo Subject?

If you’re feeling suicidal right now, this is a good guide for avoiding acting on  those feelings. Above all please talk to a friend or family member, or call a crisis line in your area – here’s a list.

In an attempt to reduce the shocking suicide statistics, we’re encouraged to talk about suicide, especially during Mental Health Week. There are 24-hour suicide lines and guidelines for reporting of suicide, especially the sudden deaths of the uber famous like Robin Williams. There are support groups for survivors – those who lose loved ones to suicide.

But suicidal feelings? Not so much. They are buried in the mush of the word ‘depression’, which is so vague it refers to any kind of low mood. Suicide is caused by depression, apparently, and therefore depression is Bad, and so is mental illness. At least these assumptions signal the community struggling to acknowledge that mental suffering can be as tortuous as physical suffering. But how can we expect the public to have the first understanding of mental illness when the sector itself is in crisis, by lack of funding on the one hand and the clash of competing paradigms on the other?

There may be support groups of survivors but there are no bricks-and-mortar self-help groups (that I’m aware of) for those afflicted with suicidal thoughts (if anyone knows of one, please let me know and I’ll mention it. There is an online forum for people who feel suicidal, Suicide Forum). There are plenty of other self-help groups, of course, for the kind of problems that can lead to suicidal thoughts. As soon as you voice a suicidal thought in such a group, a protocol comes into play. This is a good thing – it is evidenced based and its one aim is to stop the person in question suiciding, to keep them safe during the crisis. Suicidal feelings can result in death so must always be taken seriously. But it speaks to the problem of suicide – that it’s difficult for the person afflicted with the thoughts to speak about them. Once you do, the direction of the discussion must change immediately, if not come to a halt. There’s still a taboo.

Part of the problem is that suicidal feelings can actually mean many different things and arise for many different reasons. Lumping them all together could be as harmful as not dealing with their disparate causes.  I’d suggest the following categories of suicidal thoughts arising from mental suffering (I’m not an expert – feel free to offer opposing opinions or some additional categories).

Also, these categories are fluid – some may suffer from a combination of these things.

― Fleeting thoughts that everyone has. The only problem with these thoughts is that the person who has them might decide they were abnormal. I guess the internet makes that fear obsolete. 

Fleeting thoughts of self-harm during a low period are pretty normal as far as I can tell.

― OCD thoughts. The sufferer here doesn’t actually have the desire to commit suicide at all but  afflicted with persistent, disturbing thoughts and images of self-harm – a form of pure OCD known as suicidal OCD. The sufferer is not in danger of committing suicide, but needs treatment for the OCD.

― Suicidal thoughts during periods of an acute mental illness. This would include particular kinds of depression, including bipolar, that push sufferers into extremely desperate states. It might also include a psychotic episode for someone with schizophrenia. Such people might actually realise they are a danger to themselves and ring up a suicide line or admit themselves to hospital. That is, they may know that as a life choice suicide is not what they want – but they fear the illness will take over and make a terrible decision. Anyone suffering from an untreated mental illness could be at risk simply because their mental suffering is severe and they  don’t know how to reduce it.

― Suicidal thoughts provoked by unbearable grief. This can afflict all genders but males are particularly vulnerable because society teaches males to cover up and repress their feelings when they experience loss, for example the loss of the family farm or the breakup of a relationship. Some may find the feelings of grief unbearable or fear that the feelings will never change.

What these people desperately need is help to process their feelings. Often these feelings may be accompanied by unhelpful, unrealistic ideas about gender expectations, so these people may also need help in being compassionate with themselves and letting go of outdated ideas. The latest DSM has been criticised for pathologising grief, but this is perhaps because the idea of a drug for grief is so counterproductive. Perhaps it’s not that the grief itself is pathological, but that sufferers of pathological grief don’t have the tools they need to process and get through it. Help with doing that – if the therapist is willing to ‘suffer with’ the patient – can only be a good thing.

―The suicidal thoughts of someone with mental illness when they have insight. These thoughts are based on the overall quality of life, and the reality of continuing mental suffering. These thoughts could be equally applicable to someone with chronic physical illness or disability, and also their carers.

In particular this reason may merge with the previous one because any kind of illness or disability involves an element of ongoing grief as to the limitations that the illness places on the sufferer (even if some of those limitations are caused by social attitudes). So feelings of quality of life must be dealt with separately from the grief-work that is part of having a chronic condition or caring for someone who has.

What this shows is that there is not just one remedy for suicidal thoughts and impulses. However, if someone feels acutely suicidal then there are urgent things that need to be done regardless of the causes. The appropriate treatment comes later.

Dreams Hold Key to Life's Puzzles

Pic: La Citta Vita

This morning I woke with the gradual wash of a dream pulling back its hold on my brain so slowly that I was able to catch the salt granules of its content before they dispersed.

It was a healing dream, creating a synthesis of past and present in an elegant, compact way. Everyone’s unconscious is a skilled novelist in its ability to find patterns among all the disparate memories and sense impressions that people our minds.

The dream took me to a disco nightclub that was incredibly fashionable, and there I swanned around with two people from my past – yet it was set in the present. My age didn’t stop me from being relevant and accepted in this ubercool place. The two people I was with were among those I shared a house with for a short time in the then edgy suburb of Fitzroy in 1983. I have fetishised the inner city ever since this time. It represents my personal Eden, my lost paradise, my Shangri-La.

I suspect most of us have more than one of these lost worlds. My dream brought two of them together and in doing so it allowed a psychic healing.

For this dream nightclub was located in the daggy suburb of Glen Iris. In real life this was where my maternal grandparents lived when I was growing up. Their tiny orange brick veneer not only housed the remains of their own family (my mum was the oldest of eight kids) but hosted a growing horde of grandkids. The suburb was boring and middle class in that unpretentious seventies way that is gone forever – hardly the place for a nightclub!

But Glen Iris was more significant than that, because my grandfather ran a tennis clinic every Saturday morning at the tennis courts of the parish primary school. The famous ‘Mister Mac’ taught kids from all over the area, and from all social classes. Some of them came from the posh private schools, some from the humble Catholic schools and some from the ‘state schools’ as the public schools were called.

This was a cushion for a shy child. Not only did my older sister attend the clinic but some of my cousins. I had a secure base from which to socialise.

This earlier childhood experience, I now realise, is why I have obsessed about Fitzroy and its gentrification for so long. Fitzroy represents a  part of my past that I will never get back – a communal household that only lasted six months but was a cushioning influence on a harsh and lonely life in my final year of a university arts degree, where I struggled with lack of motivation, immaturity, social terror, loneliness, undiagnosed eating issues. The decrepid terrace house, before it too became frightening, was a social refuge.

The dream was bringing these two, seemingly disparate periods of my life, together. It was telling me not to worry about my own personal loss of the inner city any more, as well as the larger cultural loss caused by gentrification. For that seminal experience in Fitzroy – that unique sense of community – had already been experienced, much earlier, in a much daggier suburb. And I could therefore experience it again.

I don’t have to live in the inner city to experience community. Thanks to my peer support program, my growing up is happening right now, right here, in Gardenvale and Elsternwick.

The unconscious is incredible in its ability to show us what is happening on a psychic level. Once we start paying heed to its puzzles it rewards us with greater detail, more overt symbolism and sharper recall.

But the dream also gave me another gift. I have started writing about the social causes of mental illness. Not that there aren’t biological and genetic elements – of course there are – but a return to biology, which some psychiatrists are keen on to the exclusion of other factors, would be  a hugely backward step.

Lack of community is one of those factors, perhaps the most vital.

The dream – not just its content but its healing and synthesising qualities – seemed to be telling me I am right to pursue this line of thinking.

Because in those two different stages of my life, I experienced the strength and ballast of true community, and it gave me some protection.

And now peer support is performing this function once more as I slowly, gingerly, reluctantly, take my hesitant steps into the wider community, even as I witness that fragile community being fractured, thinned, diminished by the log cutters of neoliberalism.

Community on the macro (government policy and spending) and the micro (peer support and self-help) levels is worth not just safeguarding but enhancing. It’s not just a tool in mental health, it’s the very basis of it.

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Back after a Blog Break

Apologies for the long gap between blog posts of late. And for also deleting a previous post – something I’ve not done previously, as far as I remember. An explanation for both is needed!

First, about the break. I’ve started to get a couple of my comment pieces published online. This is fantastic – however, a few caveats. I’m not getting any editing work, and the number of hours that go into an article isn’t commensurate with the pay (who’d have thought?).

I’ve had three articles published in online newspapers/journals, and two of these were on paying sites (well that’s what they’ve promised). Of course two paid gigs do not a writing career make!

If the editing work starts back up (and it’s usual for me to have gaps, especially at the beginning of the financial year) then it would be a nice little combination – the writing satisfying the creative genie, the editing work channelling the left-brain-dominated control freak (and paying much better per hour).

But it is great for my confidence. Truth is it couldn’t have happened earlier.  I just wasn’t ready. I can’t help wanting to use the word ‘maturity’ at this point, which is a bit sad considering that I’m 51 years old.

Blogging alone has helped develop my writing – just doing it – but the willingness to bend my own concerns to the needs of the journals just wasn’t there earlier. Getting my point across in 800 words or less? Where did these people get off? Any subject I was interested in required at least 2500 words.

Now I am slowly developing the art – not unlike haiku, or any kind of poetry – of making my points succinctly. After a while you realise that it actually takes less time to write a short article than a long one, so it’s an advantage.

But it’s bloody exhausting in a way that blogging is not.

Now about the little um blog entry deletion. Self-censorship? Perhaps.

The entry was about the revolution underway in the mental illness treatment community. These changes are both exciting and controversial. (As an aside, there doesn’t seem to be a consensus in the psychiatric community at the moment about what causes mental illness, and this in itself is all at once interesting, promising and disturbing.)

I originally started the article before moving house in May, and then other concerns intervened. When I went back to it a few months later I didn’t really think the issues through before completing and publishing it. Much of the impetus had come from reading the book Anatomy of an Epidemic and the blog Mad in America.

But the issues that these changes bring up are challenging and potentially life changing for many people. As someone with OCD, who is always concerned about the effects her writing may have on others, I’m more aware now of the caution that it is preferable to exercise when covering this area.

I’m probably overly cautious, but that’s my hang up – the internet is scary in its ability to disseminate information, and change the way people behave, very quickly. When it comes to mental health, that makes writing about it a big responsibility.

The other thing that made me pause for thought was that the health system in Australia is so different from the American one. The Australian system is a chaotic hotchpotch of public and private services, and everything in between, while the US system is, in my understanding, almost completely controlled by health insurance companies.  It’s quite possible that there is more mismanagement and a greater reliance on drugs in the US, and therefore much more angst among consumers. In fact in Australia some of the new approaches, such as peer support, are being adopted by mainstream services, which is very exciting.

This doesn’t change the fact that the public system in Australia is desperately under resourced. My impression from the limited reading I’ve done is that psyche hospitals, which should be soothing, welcoming havens for recovery, are for the acutely sick only, and that after being stabilised on drugs you get kicked out quickly, leading to a revolving door syndrome for those without adequate community support (there are good community services available in some areas, but I’m not sure how comprehensive these are, and they are in flux right now).

The other problem is that I don’t find myself in either of the major narratives – the biological idea of illness and the anti-psychiatry push. Not that the anti-psychiatry movement denies the existence of acute mental suffering at all. It's just that for me, labels themselves aren't the problem - it's the kinds of treatments that they too often give rise to which need monitoring and review.

Anyway I am not going to weigh into any debates for the minute. I am very interested in writing about  new treatments, but my OCD is a factor that I need to take into account. Still, it is an exciting time that may well lead to a synthesis of the best of old and new treatments.

And whether my other writing leads to a new 'career' is something that only the future can reveal!

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Why I Called My Memoir Love Shy

Picture:  Tambako the Jaguar

My memoir, which I first self-published back in 2012, is called Love Shy. As a confirmed commitment phobe I only settled on this title after going through a string of others, starting with the first one, Splitting.

I settled on Love Shy because it suggests my main disorders while acknowledging that there was a familial and psychological aspect to my illness, a basic problem with the formation of self – it wasn’t a case of a fully formed ego being hit by a breakdown out of the blue, which is how mental illness is sometimes represented in memoir.

But the term 'love shy' is now mired in controversy and I feel the need to explain why I used it.

Love Shy is the name of a forum, now notorious, that is the voice of the Incel community – a group of primarily men who are, to put it primly, unable to ‘get any’. Incel stands for involuntary celibacy. These are men who try their luck with women, and get nowhere.

The forum received worldwide attention following the horror of the Elliot Rodgers mass murder in Isla Vista, California. Not that he was on that forum as far as I’m aware, but there is a strong anti-feminist movement associated with particular Reddit groups that some men on the Love Shy forum subscribe to. Before the shooting spree that he carried out on 23 May, Rodgers had aired his revenge manifesto in a chilling video. In the video he expressed disdain for the women who had rejected him sexually over the years, and his intention to punish both them and the sexually active men whom he despised.

The misogyny of Rodgers’s thinking would have fitted in perfectly with those of many on the Incel forum. (Which is not to say the Incel community are potential mass murderers – in the light of the murders the internet exploded with debate between those blaming the murders on mental illness and those pinpointing the structural misogyny that made Rodgers’s views mainstream thinking. It’s worth mentioning that Rodgers killed five men, including himself, and two women.)

I’d looked at the Love Shy forum before the Rodgers murders, of course, but not analysed it in any depth. The forum seems to equate love shyness with involuntary celibacy. But my own definition of love shyness is the opposite of involuntary celibacy. The difficulty in making a distinction between the two terms indicates the difference between the unconscious and the conscious minds.

My memoir details how I ran away from love and emotional involvement. It’s not that I didn’t have opportunities – of course I did. And if asked at the time I would have said that of course I wanted a relationship. But I had a phobia about love and sex, so everything I did ensured that I obtained neither. The unconscious forces within me were stronger than my conscious wishes.

Committed relationships are quite different from casual sex. In fact as a young person I was very phobic about the latter too. There was an inner saboteur (which my psyche saw as a protector) that kept me away from both love and most sex.

Those who grew up with the internet won’t understand how much harder it was then to negotiate sex in real time, without the mediation of electronic devices to let one’s wishes be known at one remove. Before the rise of the internet, when you had to have some social confidence to negotiate casual sex, involuntary celibacy was the consequence of love shyness but for me they were not the same thing.

For me, the internet made it easy to get around that saboteur because meet-ups could be neatly arranged. I can now cope with the anxiety around casual encounters, although I’ve pretty much lost interest in them for various reasons. But the internet didn’t change the fundamental problem. Nevertheless I became more open over the years, and have begun to believe that fate itself has played a role in my more recent lack of long-term relationships. I had rejected the major loves of my life over a period of years and before the advent of the internet as dating platform. Perhaps these earlier rejections of love have created such bad karma that, willing or not, real relationships do not come my way.

As I've said, I found the internet amenable to ‘hooking up’ – although unless you’re at any age where a large pool of your peers are unattached, actually finding suitable candidates for even casual encounters is not that easy. But what I realised from these experiences, as well as countless celibate ‘pre-dates’ with both men and women, is that whether you find a relationship or not is ultimately out of your control. Sure, you can increase your chances by frequent dating, joining interest or hobby groups and pursuing ‘personal growth’ (using your intuition to avoid time-wasting and dangerous situations) but, at the risk of sounding hippy-dippy, it’s really up to the universe.

My date-to-relationship ratio has been about 60:0 (this excludes casual short term relationships). Sex may seem available at the drop of a hat, but bad casual sex can actually reduce your chances of a future relationship because not only will you will need time to emotionally process the negative experiences, but they could damage your level of trust in the future. Which is not to say all casual sex is bad of course – intuition is the key here.

Some people are simply frightened of their own inexperience, or just very shy, and have been able to use the medium of the internet to start off with casual sex and then move onto relationships once they got the chance, without having any deep-seated fear of involvement. Good luck to them.

It may even be true what the male incels say about women – that most can get sex if they really want it and therefore can’t rightly be called incel.

But to my mind a phobic fear of love, intimacy and the often wordless courtship rituals that surround those things is not the same as the fear of casual sex, a fear that may be more controllable now that sex can be neatly arranged beforehand via dating sites, email and texting.

Despite what some incel men believe, it’s therefore quite possible that there are love shy women out there (using my definition)  who can get casual sex if they want to, but flee potential relationships – not that I think my level of phobia was or is very common.

I doubt very much whether most of the men on the Love Shy forum have the kind of problem that plagued me. They seem to be willing to approach women, and to ask for what they want. In their own narratives, they just keep getting rejected. Instead of thinking their own approach might be the problem they therefore conclude that women are castrating bitches.

But in a great irony, this is itself a form of self-sabotage. Patriarchy is a psychological construct and never just a social one, but male power is contested these days. Patriarchal masculinity and its manifestations, ranging from old-fashioned views on rape to the extremities of domestic violence, are often evidence of crippling psychic terrors to do with fear of abandonment and fear of female sexual power that are beyond my powers of analysis (and may also be related to early trauma).

Clearly it is not just the misogynistic views of these men but the psychic defences that underpin them that are the problem.

So perhaps these men are in fact closer to me than I would like to think, to the extent that both they and I employ psychic defence mechanisms (albeit very different ones).

Patriarchal machismo is a powerful psychic defence – but this is not immediately clear because in so many circumstances it is socially sanctioned.

The more embittered men on the Love Shy forum might do well to go into therapy with qualified psychologists who could help them to challenge their fears of genuine involvement with, and commitment to, people of the opposite gender – as well as the distorted ideas about women they have picked up.

As for me I can rail against fate all I like but the fact is that what we have done in the past always affects the present. My rejections of love have helped make me the person I am today. Being in Grow has enabled me to adopt a more philosophical approach to life, and to accept that if I follow my path I’ll be okay. But my past actions with significant others continue to haunt me.

Love Shy: a Memoir of Social and Sexual Terror is available as a Kindle e-book on Amazon. It's available on  the UK Amazon site here and on the Australian or US Amazon site here.

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The Familiar from a Different Angle - Renting, Moving and Disorientation

Last week I was planning to go to a yoga class at a neighbourhood house in the adjacent suburb of Elwood. It's a place of picture-book picturesqueness with narrow winding streets and rows of art deco apartments and intimate shopping centres with independent boutiques and an oversupply of cafes (there's also a flashy, beachy aspect that we won't go into). It is heavily freighted for me because I lived at the Elwood end of (then ultra-hip) St Kilda for one year back in 1988. Nowadays both suburbs are just ultra-expensive, but they still carry for me the weight of the bohemian romanticism that blinded me to the necessity of home ownership for so many years. Much of the charm that attracted the young to these suburbs in the seventies and eighties came from the strong presence of Jewish people from Eastern Europe who had settled there after the Second World War, bringing their rich artistic and culinary cultures with them.

I mapped out the route I would take to the yoga class using Google maps. It was a trip of only seven or eight minutes, but I have lived in Melbourne all my life and although I am not really familiar with Elwood's mish-mash of streets it is not as if they are foreign either.

Yet I could not find the place in time for the class. I drove up the wrong street and then I was in the right street but with not a clue which section of it the neighbourhood house was in. The class started at 6.30 pm. At 6.45 I turned for home feeling cheated, my attempts to reforge my life in this new place stymied. Yet there was a deeper problem. I couldn't really imagine myself at the yoga class. There was something fairytale for me in my mental image of it. As if I was fated not to make it there, because it wasn't quite real.

This raises a mild mental problem that I don’t think or talk about that much because it usually doesn’t involve suffering. It's the place in my experience where dysthymia (mild clinical depression) meets depersonalisation.

I managed to get to the yoga class the following week – I had done the trip in daylight the Saturday before, determined to know in advance exactly where the centre was. And as I waited to give my money to the short, sweet-looking female yoga teacher with the kind, lived-in face and the Eastern European features – the sort of person I associate with my traditional idea of Elwood – I started to feel slightly removed from the situation. For a few seconds I felt as if I was experiencing a memory of this event – but not in the sense of deja vu; rather, in the sense that the emotional content was simply not strong enough for the episode to be taking place in the present. It had a recycled quality. I mentally shook myself and was back in the present again, but a little unnerved. It was as if I could not take in the reality of having managed to join the class.

These feelings are not acute or frightening. They hark back to my nervous breakdown at the age of 21, when they were infinitely stronger and more threatening because I fought them ceaselessly, scared shitless as to what they indicated about my mental state. They were accompanied some of that time by the distorted sense that everything around me was contaminated by being a manifestation of capitalism. Not contaminated in the OCD sense, just completely engulfed by this overarching political reality.

I wonder now whether the content of that distortion was less significant than it seemed to be at the time. Perhaps I have a constitutional inability to fully come to terms with life as it is without experiencing it as some sort of system that represents a threat to me. I wonder whether my ingestion of the bizarre worldview of Irish Catholicism at such a young age has forged this inability. Because now the distortion has a different theme. It’s been there for a few years but has grown stronger since my move – I see everything in terms of Melbourne’s stratospheric property prices.

The social and economic aspects of depersonalisation

The homes around me don’t seem quite real, because they are unattainable – completely so in my case, but also increasingly to people of the younger generation. The houses and old-style flats in Elwood seem to have regressed to the fairytale world of my childhood that I never really left. They are, in fact, fairytales because they look and sound like real homes while being the residences and future homes of millionaires, or the playthings of rich investors. (Mansions don’t have that effect on me, probably because they represent a class that has always been there and whose wealth has always been unattainable to most.) My continued romanticisation of places like Elwood is both a defence against the realities of Melbourne real estate and an acknowledgement of how surreal house values have become in relation to daily life.

It’s confusing because the architecture of where I live has very distinct delineations depending on the area. My suburb, Gardenvale, is more ‘comfortable’ and established than East Malvern, the suburb I left, yet it’s also much less showy (a large Jewish population; people who have bought there simply because they like the beach). But Gardenvale also has elements (architectural as much as anything) of Brighton, the posher suburb over North Road, which is different again (old money and cricket stars). Then there’s Elwood, to which yet other kinds of money are attracted (rock stars, rich new agers, young professionals who love the outdoors, wealthier young families).

Yet Gardenvale itself has felt fresh so far, a place in relation to which I have no emotional baggage. I have commented on the strange foreignness of this suburb, the sense that I have moved to another country rather than an area that is 15 minutes drive from my folks' place. This has also been profoundly disorientating, but not in a bad way.

There is a further complicating factor. When I lived in inner city Carlton for five years in the nineties I was always bumping into people I knew (I’m sure this still happens to younger people who are willing to pay inner city rents). I’ve long moved from Carlton but on my fairly regular visits there I rarely bump into people I know. So there’s a feeling that I have lost my peers, and a sense that they have all moved to the inner north and left me alone (Coburg, Preston and Reservoir, inner northern suburbs which were affordable in the nineties but a long way north of Carlton, spring to mind). I think this loss of community strengthens my feelings of confusion and disorientation when I go back to old stamping grounds like Elwood. Perhaps there’s an age factor also – does depersonalisation get more acute with age, as the brain tries to process an increasing bank of memories while also taking in the present?

Perhaps my dysthymia and depersonalisation are also due to my precarious place in the social fabric. For a while I seemed to be experiencing them less often since joining Grow, but since moving house they've come back. Perhaps they are the way my mental weakness expresses the fundamental puzzle of where I fit in now. Is there any of the old St Kilda and Elwood left? Even if there is, is it actually relevant to me? What am I doing here? What does it actually mean for me to live in a particular location as a childless single woman in her fifties, who’s on a low income?

But I shouldn't talk only of my disorientation and failures to arrive. I now live about five minutes closer by car to the centre where my weekly Grow meeting is held. And only one or two weeks after I arrived in Gardenvale I managed to find my way on foot to a local Buddhist temple that I'd found on Google Maps. That first walk there was taken with the near-certainty I'd get lost but luckily as I approached the temple, a white neoclassical mansion with a park behind it, other people were converging on the property. So there was a feeling of mastery, triumph almost, at having made it to the temple – a sense that I still had it in me to settle in a new place and find new places to go.

But the sense of formlessness still returns, especially on these winter nights that fall so quickly, so early. Who is this new version of me who lives in this in-between suburb yet rushes off to Elwood? How can she relate to anyone living in either area when most of her peers will have kids and own their places? Is she ever going to stop romanticising suburbs over which real estate agents have been greedily rubbing their hands for decades, or is it possible for a suburb to retain some kind of identity beyond real estate values, a retention some Elwood and St Kilda residents seem determined to achieve?

Ah what the hell. I'm going to give up analysing and join the artists.

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Going off SSRI Medication – Pros and Cons

The following is my personal experience. Please make decisions regarding SSRIs with your doctor and any other trusted helpers. If you are tapering off antidepressants, please do it slowly.

I took the SSRI antidepressant Luvox (very imperfectly) between October 2012 and November 2013. I wanted to write some thoughts about this experience, and how I've been feeling since going off it.

Drugs are powerful things that change the workings of the brain and involve significant psychological risk. Depending on your condition it may be risky not to take them, and it may be risky to go it alone during the period when you first start taking them or when you are tapering off. This article gives no recommendations or advice. It is simply my experience. But it seems fraught to even write about that experience; drugs, for all their nuisances and imperfections, can save lives in the short and medium term, and sometimes the long haul.

For some people being on drugs, despite the side effects, turns out to be inevitable if they are to have any long-term peace or sanity. I may yet turn out to be one of those people. Then again I may not. For me at the moment, the process is important. I need to add that some of what appears to be recklessness (taking myself off Luvox last December) is partly because I had had previous experience with it and knew it was a drug I could safely wean myself from. Other drugs (and physiologies) may not be so forgiving. Also the dose I was on was very low, so it was never a case of having to wean myself off a high dosage.

Trying Luvox for the second time in 2012–13, I was a lot more self-aware; I don’t remember many of my reactions the first time around about a decade earlier. Adjusting to the drug the second time around was difficult, and ideally I should have been ‘babysat’ for the first few weeks of the new regime. This is something doctors seem unforgivably ignorant about. People going on SSRIs should be told to expect to feel very strange for a couple of weeks and to have a support system in place, even if it’s just someone to check in with by phone on a daily or twice-daily basis.

Doctors would also do their patients a real service if they checked for a history, say, of impulsive behaviour. Someone with such a history might need very close monitoring if going on a new SSRI.

First impressions

I was in the worst throes of OCD when I first started taking the drug, and the relief of those first few weeks is still sweet in my memory. What Luvox seemed to do for me was get rid of my obsession with embarrassing social interactions and mulling over possible interpretations of what I had said, done and thought. Everything was suddenly in perspective again. My brain grew still, and what a wonderful stillness it was.

But only weeks after my system had adjusted to the drug, difficulties emerged. There’s no doubt in my mind that it affected my work adversely. The silence in my brain seemed to result in a reduced ability to ‘take in’ the outside world, to grasp facts, and my memory was also affected. Now, that’s not to say it would do the same for most people; I have multiple food intolerance, low blood sugar and an incredibly sensitive system. As well, I’ve always been a bit slow on the uptake, and obsessively aware of this tendency.

My job as a freelance editor meant it was absolutely vital to be alert. I developed an elaborate system of moderating the dose if I was doing a particularly demanding job. I wouldn’t recommend this; it worked up to a point because my intuition is very finely tuned (I’ve spent years developing it) and because the jobs were short term. But it was a very unhealthy way to be, playing havoc with my moods – risk-taking behaviour for the sake of my work. I began to wonder what my brain would be like without the drug.

Deciding to quit

After about 11 months on Luvox, I noticed something that made my heart sink – it wasn’t helping with the OCD as much as it had been. In my newly quietened brain, the scary thoughts were starting to reassert themselves. One option was to increase the dose, but I was scared of turning into a zombie. Without really consciously deciding, I tapered the drug in November and December and by January was completely off it, and it began to leave my system entirely. As I was doing this I researched other SSRIs and found a new one, Lexapro, that seemed to have far fewer side effects. Early in January I was notified of a three-week full time job that would take place about mid-February. I decided to do the job drug-free, and to try Lexapro afterwards.

Without the drug in my system, my OCD was almost unbearable for a few weeks. This suggests I was taking a significant risk not switching straight to another drug. The only thing that kept me going was the thought that in a few weeks or months I would be trying Lexapro.

Having said that, I had time to work through some of my OCD issues. I did a bit of research and got a much better understanding of what I was up against. I gradually developed a more detached approach – no longer identifying with the OCD thoughts as much. Some of the fears and dreads that had banked up while I was on Luvox were gradually reduced, though never dispelled completely.

I have come to understand the difference between OCD ‘spikes’ when the thoughts come, and the ruminations that follow. I now have some post-it reminders near my computer screen about how to deal with the OCD. One of them says to accept the thought-spikes, and go on calmly without reacting to them; but to avoid the ruminations, which are much more voluntary than the spikes and more of a habit (the compulsive part of OCD).

But if I had had less of a long-range view I could have been in a serious situation. I am fifty now (it sounds so ancient!) and the brain as it gets older can take a very long-range view. So I consider what I did not to be recommended.

Back to the future?

One thing that was important to say was that some of the brain changes that took place while on the SSRI seem to have remained, to some extent. This suggests that short-term use of SSRIs could allow for behavioural changes (for example taking social risks) that, through brain plasticity, could remain do-able after the drug is no longer taken. For example, I am still able to sit through a two-hour Grow meeting, even though I only went to my first Grow meeting when I was already on SSRIs.

The meetings are harder though, and my social fears can produce some nasty spikes. Some of the ability to stay in the meeting is because I am very familiar with the majority of members. But I now have to make concessions to my fears; for example, I have been known to change seats if I felt where I was sitting was too prominent.

It became clear to me as the drug completely left my system that my general shyness was returning; Luvox had remained more effective in dealing with that than it did with the OCD. I find it hard to look other people in the eye and my OCD fears are worse.

The low-level depression I’ve gradually developed in the last 15 years has also returned. It’s certainly not the kind of depression that makes it a struggle to get out of bed, but the kind that means I’m always just on the verge of tears. And if I’m not sad I’m angry and having mini-tantrums where I throw my pillow to the floor and silently curse the great god of Destiny or Fate, the inescapability of Things As They Are. I can’t decide if this depression is the result of my lifestyle or something I’d have anyway – possibly a bit of both.

Here are the things I’m doing to counter all this:

• a few minutes mindfulness meditation as soon as I get up
• abdominal breathing exercises in front of telly every day
• free tai chi class in the park once a week
• dancing to some music with the blinds down in the lounge room most days
• about three times a week, some yoga stretches and muscle-building exercises
• University of the Third Age courses
• writing lots of poetry!

 What’s dropped out is the walking around the oval of my local park – must get into this again.

At this point, I'm not as desperate as I was before about trying out the Lexapro after the Big Job. I am basically monitoring the situation. A friend of mine who recently went off Lexapro said that he believed one of the side effects of antidepressants was 'an inability to love'. I smiled wryly at this, because while that kind of numbness could be incredibly frustrating – I couldn't always cry when I needed to, for example – in social situations it could be wonderfully freeing for me, supersensitive as I am to every tiny perception that passes through me.

So, I'm not sure what I'll do ultimately – the situation is fluid. In the meantime I am enjoying my greater brain power, trying to look after myself, and keeping a watching brief.

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Fight or Flight Response: The Paradox of Anxiety Recovery

Pic: pd breen

My feet tap insubstantial, fleeting, on the narrow city pavement. Past closed stores with quirky displays shrouded by dark; car park entrances emitting the endless chug and smell of vehicles; the plaques of narrow, pretentious galleries; and the sleek miniature lobbies of boutique hotels. The human scale of this laneway is comforting in the early evening but my aloneness beats furious in my chest.

I am small but carry with me a scrambling, sabotaging energy. It’s a boiling liquid that threatens to bubble and spill over the situation I’ve so meticulously set up – an online date.

It is this anticipatory anxiety that I remember so well from my dating days. Those walks to the groovy little cubbyhole city bars were far easier to endure than the nauseous, low-level misery of the tram or train ride into the city, as once on foot my adrenalin had a limited outlet in the forward momentum of my limbs. (Trains were worse for some reason, perhaps the larger scale of the stations compared with the more human streetscape of the tram.)

For years I would fight this anxiety, through breathing exercises and ‘self-talk’. We’ve all heard of the fight or flight syndrome. Once you’ve used your will to deny the urge to run, there seems no choice but to do battle with the remains of that urge, to use every tool at your disposal to calm yourself down.

But I slowly realised that trying to damp down my fear was just increasing it. Fear denied has a way of making itself known. Why not try to harness this energy instead of fighting it? Why not run into the situation instead of away from it?

This is hardly a new idea. Back in 1962, in the quaintly titled Self Help for Your Nerves, Dr Claire Weekes used the terms ‘floating’ and ‘masterly inactivity’ to describe her remedy for anxiety, explaining it this way:

it means to give up the struggle, to stop holding tensely onto yourself trying to control your fear, trying to ‘do something about it’ ... It means to by-pass the struggle, to go around, not over the mountain ...

More recently, experienced sufferers and therapists alike urge a general acceptance of the brute fact of anxiety before we can hope to lessen it. On the HealthyPlace.com site, Tanya Peterson writes:

When we fight against anxiety, we inadvertently promote the belief that we’ll feel better, be better, once we’ve conquered anxiety – but not before. This puts pressure on us, makes us feel worse about ourselves, and it serves to increase anxiety ... Accepting ourselves for who we are, anxiety (or other mental illness) and all, is crucial for well-being.

When we react to anxiety with further anxiety, a vicious cycle is created. If we can stay with the initial anxiety and accept it as part of the totality of experience, it becomes easier to manage.

Or does it? In fact, there’s a very big caveat to this. If the anxiety is so overwhelming that you can’t breathe, speak or walk, the idea of going with it in the way I’ve suggested above is a bit insulting. The anxiety needs to be brought down to a level where it is manageable first. And this is a gradual process, not something that can be done in a few minutes, hours or even days. It’s the stuff of daily work and practice, and often outside help in the form of therapy.

Reducing anxiety is a long-term task

Bringing the anxiety down to a manageable level could require anything from medication and a course of CBT to simple breathing exercises in front of the tele. Mindfulness in the form of meditation or mindfulness exercises is a great way of doing this, because it fosters the very acceptance that anxiety sufferers struggle with.  or And unless you’ve been floating around in orbit for the last twenty years, you’ll know that exercise can also be helpful.

For years I had a very bad problem talking with clients on the phone. It was so severe that the kinds of advice you get on the internet for treating panic attacks were laughably useless. The irrational terror was so extreme I wanted to scream. Anything I could do in the situation itself was impossible, because the raw, visceral fear that eventually even the sound of the phone ringing provoked was just too high. Sometimes the only sensible thing to do was not answer the phone at all.

In the end, drugs were the only thing that helped. They gradually gave me a level of confidence that has remained to some extent even though I’ve now stopped taking them. (Which is not to say it’s fun, or easy – it’s just do-able now, most of the time anyway.)

Some basic CBT has also helped. I understand better now how sensitised anxious people become to our reactions. We become hyperaware of every bodily reaction and thought, and frantically try to interpret them. We react as if every sign of anxiety is inherently dangerous. This happens so quickly at the neuronal level it’s impossible to stop, but just being aware of the process has helped me become a bit more detached.

There’s another reason why riding with the anxiety isn’t as easy as it sounds. Often part of the anxiety itself is a fear of what others think, and the imperative to hide our discomfort sometimes seems to be a matter of life and death. I get annoyed at how scared I still get, in social situations, of looking scared, and the high standard I demand for my level of confidence. But at least I don’t respond to these expectations like I used to – in the past, I would either put on a show of extroversion which was painfully transparent anyway, or withdraw further into myself, horrified, if I could not hide my fear.

All this is to say that the very basis of recovery for me is that it is always provisional, always incomplete. (I don’t want to suggest that I’ve conquered my anxiety – there are plenty of situations that I still avoid, although I have made progress.) Recovery involves a major contradiction – a fundamental acceptance of the impost of anxiety, and a willingness to harness its energy, along with a long-term plan for reducing it. Embracing this contradiction is a daily challenge.

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Eco-Anxiety: The Challenge of Being Green and Anxious

Pic: Shehal Joseph

It’s going to be 43 degrees Celsius in Melbourne today – a ‘scorcher’. I’m at my PC, noticing how rapidly my hair is drying and trying to figure out how soon I can dash off to the shops for supplies before the air starts to bake. The milky blue of the morning sky is threatening somehow. It seems like a good time to complete my blog entry on the challenges of having anxiety, or any sort of mental illness, and being eco-friendly or simply aware of the issues, ie climate change.

There is a vague menace in heat waves for me that makes the difficulty in sleeping, especially early on in the heatwave, almost certainly psychological.

It’s not just the magic figure of 43 that is stressing me out today, but the fact that it’s the second day of what will be a five-day heat marathon, with four days of temperatures 39 and above. I picture myself by the end of it a frazzled, dried up twig, mentally scarred for life by my ordeal.

For the fact is once my double brick house starts to cook, if I don’t take adequate cooling measures I quickly go into an odd dissociated state of mind that makes me incapable of taking positive action. The trouble is that this state creeps up on me before I have time to prepare, so I have planned for it this time, and will probably end up in the local library by early afternoon. Later in the week, once the sun has started to set, you might find me wading into the dirty water of Elwood Beach, oblivious to the frenzied chirping and splashing of the crowds who actually think it is FUN to cool down on a hot day and not just grim necessity.

Heatwaves are made more likely by climate change, which leads me to the original topic of this blog entry – it’s not easy being green, and it’s especially not easy if you have any type of mental illness.

I need to acknowledge from the get-go that poor people – and many of us with mental illness are poor – produce very low carbon emissions anyway.

One thing that annoys me about this is that we don’t get social credit for our small carbon footprint. No-one congratulates me on not having replaced my 1997 Starlet with a new car in the last few years but they would probably pat me on the back if I bought a new Prius. Yet I am saving more emissions by not buying a new car, because the emissions involved in producing the Prius would probably be higher than the extra emissions from continuing to drive my little four-cylinder. Similarly, I get no kudos for not having an air conditioner to help me through the heatwave (although I do get plenty of sympathy!) I know someone on disability who doesn’t heat his house in winter, and he’s not earning any awards for Best Green Citizen of the Year. Of course, many of us don’t have cars (that may also be a conscious choice).

But what about voluntary green actions? These often involve extra effort, such as shopping at an organic grocery store that may be further away than the local supermarket. They also require additional planning, eg having enough plastic bags in stock, and remembering to take them with you when you go out. And often (but not always) buying green products is more expensive than the conventional option. As well, with automated checkouts, the anonymity of supermarket shopping can seem so much easier.

If you do have a car, it’s tempting to drive to a social event rather than taking public transport because you don’t have the stress of waiting for the train or tram, or battling your paranoia about the other passengers and any other worries common to anxiety sufferers; then there’s the quick get-away that a car makes possible if the socialising gets too much.

The irony is that people with mental illness can struggle just doing normal things, while conscious green actions require a kind of super-normality.

But being green is also important for many people, whether or not they have mental illness. This is because meaning and purpose are vital to wellbeing, and making an effort to be eco-friendly can provide some relief from the feelings of guilt, fear and anger that the ecological state of the world can ignite.

However, I have no illusions about the limits of said greenness in the scheme of things. In a free market economy where both major parties in Australia are centre right, the idea of doing the right thing – and being viewed by various industries as a niche market for your trouble – can be demoralising rather than empowering. The sense of helplessness this situation engenders can lead to depression, so it’s tempting to ignore the whole issue.

It’s true that nothing I do personally, in my day-to-day practical life, is going to affect climate change significantly. That idea is itself a form of greenwash, brought to you courtesy of the fossil fuel industry and big finance, which between them are investing in enough coal mining and exporting to send the planet to buggery in a few hundred years.

It is also a depressing fact that wholefood stores are generally just as profit focused as the evil supermarkets. It is highly likely that your local organic store is not using green power, for instance, and if it the company is growing, its carbon emissions may actually be increasing.

And buying a green product from a large company that mostly manufactures non-eco-friendly products is tokenistic at best. I bought a diary this year that was carbon neutral, but the company as a whole is anything but, and produces plenty of products that aren’t carbon friendly at all. If you’re going to buy green products, I’d suggest buying them from a company that is trying to do the right thing with all its products, not just one or two that have been created for marketing purposes. The book Greenwash by Guy Pearse has enlightened me on this distinction; it has all the dirt on who’s really doing the right thing in the corporate world, and who’s not.

Yet I don’t see my tokenistic green actions as a complete waste of time, money and energy. I see them as contributing to a more eco-friendly culture – one that will hopefully grow stronger in the long term, and is waiting in the wings for when climate change has become such an emergency that even the most cynical powerbrokers are forced to act.

Also, when I buy from wholefood stores I am at least protecting diversity (Australia has one of the most concentrated supermarket markets in the world, dominated by the duopoly of Woolworths and Coles) and supporting small suppliers. I’m also planning to put my money where my mouth is, by moving my term deposits entirely away from the big banks at the end of the month. This will not only increase my support for local credit unions but it will give me a lovely, revenge-y feeling – I can’t wait to tell the NAB that my money’s no longer going to support their dirty investments.

It’s also the case that being slightly greener can sometimes save money, for example buying from op shops or thrift stores. This retail model is flawed too, I know, because it relies on a certain amount of consumers to buy new products to donate. Yet there is so much good in op shops – the volunteers and what they gain and give, the programs that the profits go to support, and the idea of re-using someone’s discarded junk instead of having it consigned to landfill. A few op shops have been set up to include an element of repair and restoration, and it would be great if this model was adopted more broadly.

Then there’s the wider recycling movement, which is literally redesigning the culture of consumption – fix or repurpose things if possible; if you do create something new, build it to last; and borrow, share and rent rather than buy.

Well, my hair is now dry so I am dashing off to the shops – sadly, it must be admitted, in my car. The irony is that it’s even harder being green during a climate-induced heatwave, especially if you’re heat-phobic. Which leads to my conclusion, that I now take small green actions when I can, while voting for the Greens, the party that wants to take big action. And when I can’t be green because of mental issues or finances, there’s no point in bashing myself up about it.

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Silver Linings Not All They're Cracked Up to Be

I finally got around to watching the comedy-drama Silver Linings Playbook the other night. The film’s hero, Patrick Solitano, is a sufferer of bipolar whose problems stem from his initial refusal to take medication. I’m not exactly the first person to watch it through the lens of mental illness, and to be judging it poorly on its portrayal. Yet it’s been critically acclaimed and has received a huge number of accolades, won Jennifer Lawrence an Oscar for Best Actress and and has a 92 per cent critics rating on Rotten Tomatoes.

Actually, the parts of the film that did deal with mental illness weren’t uniformly terrible. If the humour is done in the right way (ie laughing with, not laughing at) the travails of trying different drugs and putting up with the side effects until the right drug is found can have a funny side. The ability to laugh at difficulties is an essential tool for getting through any chronic illness, and also a way of educating non-sufferers.

However, while Patrick and his potential romantic partner, Tiffany, initially toss drug names and their side effects at each other in a humorous way, once Patrick is resigned to taking his meds the film as a whole simply forgets that both of them are on drugs. There are no more side effects, no having to get off one drug and try another, just two people trying to be human. Which is fair enough, but the loss of drugs from the narrative, which implied that both characters were on stable regimes that enabled them to enjoy complete sanity, made me wonder whether the film had been funded by a drug company.

But I don’t want to give the impression that this was the sole thing wrong with Silver Linings. I wish. No, it was the script and the characters. There is a certain kind of Hollywood humour that consists of people starting off on a high register of emotional conflict, and staying there. Part of the humour in these films consists of people being rude and abusive to each other. This is the style of Judd Apatow, who directed and cowrote films like The 40-Year-Old Virgin and Knocked Up. It has been hugely successful, so much so that other writers have adopted it (traces of this style can also be found in The United States of Tara).

This, sadly, is the style that dominates Silver Linings Playbook, courtesy of writer-director David O. Russell. Robbie Collin of the Daily Telegraph said there was ‘a tiring fruitlessness to the mayhem’ of the film, and I couldn’t agree more.

I didn’t entirely dislike the characters – there is something brooding and interesting behind Jennifer Lawrence’s Tiffany and she’s such a good actress she gives every character resonance – but the script makes her a lonely bad girl in a way that is cliched and boring.

But no movie experience is a complete waste of time. It was actually quite timely – well, spookily timely – sitting there and watching the hero deny his need for meds. I have just been going through the same thing – coming off Luvox because it had stopped working, trying to exercise to compensate. Then my back gave in on me and my mean sister told me that she had noticed I wouldn’t look at her.

So I did some googling and found an SSRI called Lexapro that seems to have fewer side effects than other SSRIs. I am seeing my doctor and hopefully getting a prescription when the surgery gets back from holidays next week. (Art imitates life, or is it the other way around?) I wish I could be confident of ending up as functional as Patrick is by the end of the film, but I fear that my experience with Luvox will be repeated with Lexapro and I’ll have to switch again. Watch this space ...

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Memoirs of Madness: Five of the Best

The memoir of madness has been with us far longer than Sylvia Plath’s Bell Jar or William Styron’s Darkness Visible. Firsthand accounts of life beyond the limits of sanity have been around from at least the early nineteenth century, as this alluring bibliography attests. 

Below I’ve picked five of my favourites, all dealing with illness that includes elements of psychosis. I’ve chosen these memoirs because they are all vividly written and because they provide vital insights into the treatment and lifestyle needs of people with mental illness. Each and every one of these memoirs makes the loud and clear declaration that it is never more important to view the mentally ill person as a complete human being with human needs and emotions than when they are most acutely ill.

Madness: A Bipolar Life by Marya Hornbacher

Already a classic in the field, Hornbacher’s riveting immediacy, hold-onto-your-hat style and liquid prose make this memoir un-put-down-able, even as the reader squirms. She ignores her bipolar diagnosis, ditches her medication and descends into alcoholism, destructive relationships and psychosis before colliding with the consequences of her illness and making a slow journey back to sanity. Meeting her husband Jeff, finding meaningful work and suffering extended stays in a psychiatric ward are all part of the fabric of this painful and visceral but ultimately uplifting memoir.

Madness: A Memoir by Kate Richards

This memoir is written in the tradition of Hornbacher’s but Richards has a talent and voice that are hers alone. Richards’s seductive prose demonstrates that great pain and suffering can actually amplify the sensory perceptions that make life rich and meaningful. At the start of the memoir the narrator’s psychotic depression has left her an emotional adolescent, addicted to sleeping pills, dependent on alcohol and lacking in life skills. But sustained by music, literature, philosophy and the outdoors, meaningful work as a medical researcher, strong friendships and the support of a wise psychologist, Kate and the reader emerge into the daylight – with all the down sides as well as the joys and possibilities that stem from coming to terms with life and chronic illness.

One of the key strengths of this memoir is the passages written while the narrator is in psychosis, seemingly drawn from Richards’s diaries. They explore the limits of meaning, collapsing the difference between subject and object and demonstrating the dangers and lure of madness. At the same time the memoir encompasses vivid accounts of episodes in psychiatric hospitals and a grounded critique of Australia’s mental health system.

Flying with Paper Wings: Reflections on Living with Madness by Sandy Jeffs

Sandy Jeffs is a popular Melbourne poet and an acclaimed community educator on mental illness (in her own words ‘professional lunatic’). In this honest and moving memoir she reflects on a life lived with the chronic illness of schizophrenia following a semi-rural childhood riven by constant battles between her alcoholic mother and violent, controlling father.

Jeffs’s experiences in Melbourne mental hospitals from the 70s onwards, mostly harrowing but occasionally affirming, the stubborn viciousness of her inner voices, the sustaining support of her alternative family, and the world of literature and philosophy that feed her intellect and spirit all enrich this narrative. Entirely lacking in self-pity, this is a document imbued with the wisdom and clarity of a well-lived and nurturing life despite mental health that is at times precarious, with plenty of useful lessons for carers, professionals, policy makers and the general reader.

Hurry Down Sunshine: A Father’s Story of Love and Madness by Michael Greenberg

Photograph: Marion Ettlinger

This is a poignant and beautifully written memoir about bipolar disorder from the perspective of fatherhood. Greenberg narrates the horror of watching his beloved daughter Sally switch suddenly into bipolar psychosis at the age of 15 and eke out a slow, shaky recovery in a no-frills Manhattan psychiatric hospital during a sweltering summer. It is meticulously and delicately written in a realist style that conveys the heaviness and various losses that result from watching a loved child disintegrate, as well as the financial stresses of living in New York, and of dealing with an inflexible, privatised health care system.

Greenberg describes madness as something that takes his daughter far away from him, and vividly conveys his fears that she will never return. The awkward encounters between his current and his ex-wife, the eccentricities of the other patients, as well as the burden he already bears of supporting a mentally ill brother, ground this memoir in a complex and challenging context.

The Center Cannot Hold: My Journey through Madness by Elyn Saks

Elyn Saks is a tenured professor of law and psychiatry at the University of Southern California with degrees from Oxford, Yale and Vanderbilt, and an expert in mental health law. She has also had the experience of being forcibly restrained for hours on end in psychiatric wards and forcefed medication while suffering acute psychosis. This memoir describes Saks’s struggle to accept and manage a diagnosis of schizophrenia, while forging a stellar academic career.

Saks first experienced full-blown psychosis as a young postgraduate on a philosophy scholarship at Oxford. In The Center Cannot Hold she documents her torturous journey towards accepting the severity of her illness and the need to take medication. During this period she was able to avail herself of skilled psychoanalysts who understood the emotional content of her delusions and enabled her to maintain some degree of equilibrium.

Saks gives important insights into her state of mind during her most acute episodes and how traumatised she was by the dehumanising treatment she experienced after suffering a breakdown at Yale. Key here are the human aspects of the illness – the way it is affected by stress, Saks’s struggles to maintain her academic career, and the shocking attitudes of psychiatric staff who valued compliance over healing. ‘While medication had kept me alive, it had been psychoanalysis that had helped me find a life worth living’, Saks asserts. The support and intellectual engagement that her career and her academic colleagues provide, her ultimate acceptance of the need for ongoing medication and her fulfilling marriage in her mid-forties together enable a life that is ‘rich and satisfying’.

Narratives of madness

These memoirs are riveting yet educational reads for the general public, as well as important guideposts for sufferers. But they are also vital documents for mental health practitioners, akin to qualitative research about the experiences of users of mental health services.

Three of them, Madness: A Bipolar Life, Madness: A Memoir and The Center Cannot Hold, contain a similar trajectory – after experiencing the extremes of the illness, sometimes worsened by addiction, the sufferer eventually comes to accept the need to take medication and to manage addictions and stresses, and learns how to maintain a balanced, fulfilling life. 

This trajectory suggests that if the right level of support and skill were offered early enough, sufferers might be able achieve recovery without the self-destruction and descent into addiction that are so commonly represented as necessary stages on the journey.

All five of them reflect on the human elements that make the long-term management of illness – and just as important a fulfilling life – possible.

In The Center Cannot Hold and Madness: A Memoir, what makes this journey possible is the loving, sustained attention of therapists who provide a safe psychic space in which the patient can explore emotional defences and gradually embrace maturity.

In Hornbacher’s case it is her ever-patient psychiatrist, the hospital she lives in for months on end, where staff are unendingly accepting and supportive, and the unconditional love and fortitude of her husband that together create a safety net in which she is harboured until the illness is tamed.

In Flying with Paper Wings, it is Jeffs’s ‘two Demeters’ – the female friends with whom she has lived in a peaceful setting on the rural fringes of Melbourne for 30 years.

In Hurry Down Sunshine, it is the sustained love and attention of Sally’s family, including the father–narrator, that eases Sally's transition to precarious sanity.

Creativity, purposeful work and strong friendships also play vital roles. Secure housing is vital and the fact that most of the stories feature middle class sufferers is no accident. Kate Richards expresses how lucky she is to be able to afford to choose her own therapist, and to buy a home that offers not just long-term security but a haven.

One of the reasons for the importance of these memoirs is their various critiques of the psychiatric profession and the mental health sector.

The memoir of Richards, a medical researcher, has not one decent psychiatrist throughout its 200-plus pages. Not one. They are helpful in dispensing medication, but the healing she receives comes from a psychologist. The implication is that the problem is systemic, due to faulty training – Richards is ‘sacked’ by one psychiatrist, while others demonstrate various levels of boredom and disengagement.

Sandy Jeffs also questions psychiatry, having left her long-term therapist, Dr Y, after 27 years. She is critical of what she calls ‘Fastpsychiatry’ and ponders the dangers and possibilities of investigating the psychic content of her delusions with a new therapist, Dr K, who is willing to explore with her the darkest underpinnings of her hostile voices: ‘If I could heal that little girl, would the persecutory content of my delusions and voices diminish, and allow me to embrace her?’

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