英语语言学习：双相型障碍

Hi, it's the All in the Mind podcast, I'm Lynne Malcolm. Today we go to Ireland to hear one man's story of living with bipolar disorder.

Ian is in his mid-fifties, and despite his illness he has an enviable, almost idyllic life with his wife and three children. Today's show is an abridged version of the documentary My Mind Was a Stranger made by Ian's friend, Éamon Little. It's a poignant and sometimes confronting insight into Ian's experience with bipolar.

Ian: As a young boy I just remember being full of adventure and excitement. Everything was a thrill for me. I could see fairies every place. I used to bring my parents out to the trees and point out the fairies to them. We lived just outside the village of Adamstown in this wonderful, small, asbestos prefab house. It was one of the first of the Irish ideal homes, so it was one of the first homes displaying Tintawn carpets and Scarriff chipboard and an all-electric immersion heater and a flush toilet. It was perfect.

As children we basically ran the farm. We fed the cattle, we cleaned out the sheds. As we got older we milked the cows. We had two cows and we would milk them in the morning. That was all considered to be part of childhood living. For me it was just a very carefree, enjoyable existence.

I was always very driven, even as a kid. I had a huge amount of energy, so I do remember at Christmases sticking my head in the window to see people watching West Side Story or whatever on the TV, and I would be more excited just making things out in the shed, some kind of toys and things that we'd be playing with.

A neighbour used to say when I was a kid, 'He's going to be a millionaire by the time he's 20,' because I was breeding my dogs, and I'd be buying heifers. I sold my first heifer in the mart when I was only 11. I had this determined attitude about everything, and that you could achieve whatever you set your mind to and it could be done and all that.

Then that will left me. And when it changed, my mind was a stranger. It was lost to me. And it was quite sudden. In the morning I couldn't get out of bed. Everything was a struggle; speaking to people, going up to school. I just didn't understand who I was or what I was. This new state I was in was sinking everything very quickly and with huge density, just like pulling everything down. So at night time I would get to bed as early as I could and just lie in bed dreaming of a huge drill going down through my head, tearing my brains out. I would kind of delight in these gory thoughts of ending my life, of it being over. The only thing that had some relief was that escape of the bed at night time.

In college, years later, I could spend 16, 17 hours a day sleeping and I'd get up in the middle of the night and there was nobody on the streets in Limerick, just me and the stray dogs, taking scraps out of bins. These states or these depressions, they would go on for months.

My escape route began really when I was probably 14 or 15 and started drinking. I would work with a local builder, and every weekend I'd get a bottle of brandy. Then when I went to college, large amounts of spirits was still a big thing for me, and I had the freedom to do it. It was a great escape.

Then I discovered cannabis or cannabis derived substances. The first time I smoked dope, that's weekend I only left the flat a couple of times. And it's like I had discovered a whole new world. I started arranging things within the flat and really going into something inside myself that I hadn't touched before, a way of connecting with my surroundings. And I'm not a laughing kind of guy, I never have been a smiley, laughing person, but that was one of the true releases I got smoking dope, the ability to laugh.

The other thing was I discovered I could do amazing stuff when I was stoned; essays, engineering projects that would get top of the class, and I was getting top of the class. Until one final exam that I did stoned. But I did find within myself a creativity that I didn't know existed. And I thought it was only unlocked with cannabis. I didn't realise that I could access it in any other way.

I went to London and had a really very, very crazy time. I was getting higher and higher all the time, I really felt that I could do anything I wanted. I had no fear, there was no danger. There was a girl that I very much wanted to be with and she didn't need me at that time. That almost ended in tragedy. The only thing that saved that tragedy was the interruption of another person.

So after that night I fled to Amsterdam. In Amsterdam I was sleeping on the street in the beginning and eventually got into a squat and started to get some night work in the Sonesta hotel. Saturday night, it was 10 August, and I sat in Dam Square and I had started doing sketches in a diary I had, these were very simple stick drawings but I'd have the name and the date and the place. I wouldn't get paid for a month, so I had no money and I was living mostly from the plates where I was washing up in the Sonesta, whatever was left over, very good food coming in, and I never had a problem eating like that.

And I was walking down into the Leidseplein, And I had enough left maybe for a cup of coffee, about 50p, and I could just see phones every place, phones and phones, in the lobbies of hotels, they just were jumping out, like they were animated. I saw a kind of a message and had to respond to a message, I've got to connect and ring someone. So I got to a phone box, and I had so little money, it went down so quickly that it started beeping almost immediately when I rang home. It was answered by my aunt, she could hear it beeping already, and she just said 'Where are you?' And I said, 'Amsterdam.' She just had to say very quickly, 'Your father is dead.'

When I was going through some of the stuff that I had brought back from Amsterdam I came across these two pages, 'Dam Square, August 10'. So that's how I know it was exactly at the time that my father died that I did a drawing of him and my mother in a swing boat titled 'mum and dad having fun'. Then on the next page I had the two of them just standing side by side holding hands saying 'mum and dad'. That diary was a great source of comfort and solace to me months later. I just realised that there was some big connection in the world, that at the moment when he was dying and leaving this earth, I was somehow connected to him through this drawing, through what I was doing, and that no matter how much he might have refused to accept or forgive me for who I was or what was going on at the time, we were connected in this way, through the universe, through God, through a pencil drawing, through whatever. But it was for real, it was dated, it was timed and couldn't be refuted.

After his death, more and more connections seemed to become evident in my life, in my daily life, like things that were happening, people I was meeting. It was actually becoming unusual to meet somebody where there was no connection. It's like this connectivity had opened up and was never closed again.

When I began to notice these connections I was almost electrified in my life, I was doing things all the time, I was moving, I needed to sleep very little. Every day was a delight. I started to collect and take magic mushrooms, pursuing some kind of enlightenment. I was just coming up with all kinds of theories about nature. I left my shoes and discarded nearly everything I had and just walked, and I could see the trees signalling me and showing me the direction. Houses looked at me, like the windows and the front door, with the eyes and the mouth, and the same with the cars. I might have to say something three times, or tip my cigarette three times, three little burns on the back of my hand, just to cancel out this…I was filling in notebooks with all the revelations. So I covered my body in black and red gloss paint and I was rubbing all kinds of things into my body and my hair, like earth and tar and anything I could find on the road. I was the person chosen, that I was going to be a kind of acupuncture point that would heal the world.

And at this stage I hadn't slept for many, many, many days. And I kept walking up into the mountains, chanting continuously, so ecstatic with the world, and yet crying. And the revelations were coming at an ever-increasing speed. Everything was arriving at me at once.

Eventually I came down off the mountain and stuck my bare feet into the fire. People pulled me from the fire and they got me in the car, and I didn't know where I was being driven but I had a police escort to wherever I was going. Surely they were bringing me either back to Adamstown or to some place far greater. And they drove me to Waterford. And I don't even know if I knew it was a mental hospital, but I just collapsed in the car and refused to move. So they had to carry me in.

And even in the hospital I felt, yes, this is where they bring us, this is the place, this is heaven, and this is where we are brought, all us souls that have made it through. And I could relate to each and every one of the other people in the hospital, and we could discuss things at an incredible depth and we were all on the same wavelength, and we were treated like kings and given plates of food and given the brew of the time, but it was like a really sweet syrup and I would drink as much of it as they wanted to give me, I thought it was the nectar of the gods they were giving me.

And no matter how much of these very high doses of sedative I was given, I was still completely wired. I was put into the lock-up ward and it was a strange, crazy place, and it was just one huge room with chairs all around and it was mostly old men, the incurables I suppose.

I'd been in hospital a long time, and the problem was that I wasn't going down with the medication, I just wasn't going down. A lot of blame was being put on the amount of drugs I've taken and that I'd put myself out of reach of the sedatives and antipsychotics, I was just completely out of reach for them. But eventually over time they did kick in, but that was after months of treatment. And at that point I was in their hands, they could work with me then and they could keep me down. And then I went down. And when I went down, I went completely down. All of that incredible magical stuff and revelations and knowledge of the earth was completely gone. There wasn't really much of a memory of it or a feeling of it or a trace of it. And just a really deep depression took over.

Then once I was malleable, let's say, I was told I was a drug addict, so we had to work with this drug addiction. And it was only from a doctor in Limerick when I went back to college who I explained I had been a drug addict and when I give up drugs, that's fine, I can come off this lithium. He looked at me and said, 'Has nobody explained to you? You've been diagnosed with manic depression,' what we call bipolar illness nowadays. And I said, 'Do you mean I've given up smoking dope, I've given up drinking, and now I have a mental illness?' And for me there was really nothing cool about having a mental illness. I didn't really mind being a drug addict, there was some cool factor there maybe, but having a mental illness, that really wasn't what I had signed up for. And he said, 'Yes, you've got manic depression.' I said, 'So I take lithium and I never get sick again, is that how it works?' And he said, 'Pretty much, yes.'

Several people had colluded around this convincing me that I had been a drug addict. For me of course it was a great disappointment that my family couldn't openly discuss or accept the idea of mental illness. Even in recent years, if I have an episode and I'm getting a sick cert signed, most doctors will not want to put down 'manic depression', and I often insist that they write 'manic depression' or 'bipolar disorder'. And often they will say, 'Well, let's put down 'anxiety'.' And I'm thinking, if we're going to let's put down shit on forms, it's because we can't handle what's happening in somebody's life when they are unwell. And I think actually the biggest danger in today's society is for well-off, middle-class people who have mental illness, because they can go to a doctor and the doctor, to preserve their standing in the community, can try to collude with them into some false diagnosis or pretending something so that we don't have to address the nasty facts.

In Limerick my psychiatrist advised that I don't go to India, particularly when my chief interest in India was really cheap dope and a free kind of a lifestyle. And instead he suggested that I should go to a European country, and he said Germany would be a very good choice. I went to Germany and I ended up in Nuremberg down near Dutzendteich and the Stadion and Hitler's marching ground. And it all became very, very relevant, where I was living, what I was doing, my role in the whole exoneration of the German race and bringing their souls into freedom. And the upshot of that was leaving my job, being told by the guy driving the van that, 'Isn't this a van you'd like to drive,' and taking that as a signal, going down in the middle of the night, the keys of the van were in the ignition. It was like the whole thing was prepared for me. And I took the van and went what would be considered as joyriding through Nuremberg, but in fact for me it was a whole significant route through the city. And then getting chased by the police cars, going down tramlines, meeting trams, reversing back, trying to get to the main train station to escape on a train, and I knew that was a sacred place because they sold Sweet Afton, my favourite cigarette.

Just getting to the station, they surrounded me, the police, and so I rammed a police car, and the next thing I felt was a gun to my head and I could smell the steel. And they kicked me to pieces when they got me because I had escaped and gone down one-way streets and stuff like that.

I've never been medicated for depression because the depression has never been the thing that worries people about me. So I've always come around depression and it's usually time, just time. I guess other things that you do, like in changing your behaviours, like not allowing yourself to sleep for 16 hours a day and making yourself function in that do improve things and bring you back to normal living. But I don't see any short circuits in depression. And even now when a depression sets in I just say okay, this is going to be months. I just make a routine and I just go with the routine.

Very few people would know I'm depressed. My wife can guess sometimes, not always. Depression gets buried very deeply, especially in people who are very used to being depressed. You can do most normal things. There might be the occasional vicious outburst or an apparent tiredness or something, but you can wear that mask for as long as you need to in those moments you are with people. And that's why I think it's often no shock when suddenly somebody is gone. And people were saying, you know, there was no signal, there was no signs. But sometimes I will say when a depression is over…I'll never speak about a depression during it…'that was a really lousy springtime', while everybody else was really enjoying the spring, I would have been dreaming of suicide plans. Because for me to have an escape plan is part of my escape from depression. And I wouldn't have to consider other ways of doing it, and I would agree with myself to hold off. But it was only twice in my life when I would have actually really planned and attempted to execute a suicide. And in both instances I was interrupted in the most uncanny circumstances.

Lynne Malcolm: You're with All in the Mind on RN, I'm Lynne Malcolm. Today we're hearing one man's account of living with severe bipolar disorder. We heard how doctors were more concerned with Ian's mania than his depression, but in his early 20s, on returning to Ireland from Germany, Ian went to stay with student friends in Limerick, one of whom had lost a brother to suicide only the previous year. Unable to bear his depression any longer, Ian devised a meticulous plan to take his own life.

Ian: The morning arrived, everybody had left, and I went into the garage, got everything prepared, and I wasn't leaving anything, I didn't want messages, notes, explanations, I just wanted out. And the moment had arrived. And the garage door burst open, and I tried to look like I had some purpose there in the garage, completely flustered. It was the housemaid whose brother had committed suicide who was there with his bicycle. So in the following days I went out along the railway lines looking for obscure places, and over the course of those days things changed, and again, once the change came, the change was immediate, back into a positive sense about the world.

I remember making the decision after the second time that, okay, in future I can make my plans but I will just hold off and hold off and hold off, but I won't prevent myself from making the plans. And that making of plans has become for me so far a release valve. So when I get those suicidal tendencies and depression, I can say, okay, here is how it would happen and here's the plan that I would use. Now let's get on with the hard work of waiting this out. And sometimes that wait just seems too long. Sometimes it goes on for 10 weeks, it goes on for maybe nearly three months and you're just getting worn down more and more. And for me if I wait long enough, so far it has always changed, and that's the danger point, because when it changes it's normally not a gradual swing, it's a really rapid swing into energy mode. Loads of thoughts, loads of activity, and that's what is considered a danger to society, a danger to myself, and that's what people want to stop. That's why I say I've never been asked by psychiatrists about the dangers of my depression because it's the dangers of my mania, of my psychosis that are of such concern.

And if I am proud of any achievement in my life, I would say I'm proud of the fact that I can weather those storms on my own, totally unaided, with no help from anybody. And in fact I don't truly believe that a lot of people can help. I think you have to do a lot of that hard work yourself; resisting impulses, holding down all kinds of violent, destructive, terrifying thoughts and just letting them run through you, and just letting it go through until it's all over, knowing then that it's safe again and you can relax a little bit and start to enjoy life a little bit.

I remember the first time coming out of a really deep depression, realising that I had beautiful toes. And I've got massive spades of toes, but it was just because after months and months and months I could see beauty.

It's at 13 now, episodes. You know, sometimes when things are rising and I see things happen, lots of coincidences happen, not just coincidences but things really very synchronous, like things just happening on the moment, at the minute, like I walk in the door and the person I've just mentioned is standing there to meet me and they are holding something that I've been thinking about, and everything is falling completely into place. It's very difficult to try and hold myself in reality because the seduction of mania is just so powerful and so irresistible.

When it does happen, the next thing I know is I'm doing something out of order or saying something very inappropriate, and there's a hand on my shoulder, and it's often my wife saying, 'We've got to get you to hospital,' because literally within hours I can get into a very, very deep manic state, and to such a point that the hospital now has given me medication to keep at home, antipsychotic medication, just to take it immediately, even before arriving at the hospital because they know minutes count basically.

When I say I have an episode, it really means that I'm in a psychotic state where there is something else controlling my life, rather than the normal, average reality. And in that state I allow myself to be reachable. Sometimes it takes great effort, but I do allow myself to be helped, for people to force help on me, even though I may not want it. And the reason I respond so obediently in those cases it is because of the times in episodes when things have happened where I think I am doing something great for the world and then later I realise through somebody else's testimony or somebody interrupting me that I have been about to do some great harm.

In recent years I have developed better strategies to deal with the episodes, and that has meant that they have been shorter in duration. Quicker action, also better antipsychotics that work for me a lot better.

When I was in the hospital in Germany, the diagnosis I got was that of cannabis psychosis. It means that the psychosis that I was exhibiting was induced by the use of cannabis. They had done really detailed tests on my head, plastic swimming cap on the head in a dark room, which I found was amazing, and as they were doing it I knew they were going to recognise my brilliance in there. And that's why I was shocked when they gave me that diagnosis. It took four years to eventually leave the smoking dope and the need for it. But many other things changed with that.

Lithium is considered as a balancer. That's something that I take all of the time, whether it works or not. It may do some good, I don't know. I've had as many episodes with lithium as without lithium. But the big advantage for me in taking lithium, for years I didn't take remedies and fought with the hospital authorities about medicines. And when I decided to take the lithium, I get so much help from the hospital, particularly when I go back in and say, listen, I don't smoke, I don't drink, I don't take drugs, I don't overstress myself in the workplace and I'm still having an episode, why is this happening? Are they just answer very honestly, we don't know.

So the episodes now haven't been as severe in recent years but they are as sudden, because it's like I am always close to that edge, and if something happens that brings me to the edge it can just be a couple of days and then it's hours, like, into the extreme mania.

I've made it. Like, I've made it this far. This is as far as my father and my uncle and lots of people made it in life and they had very healthy lives, so really I feel I have been very fortunate. I've never managed to do such great harm that it has resulted in me being made a criminal. It's very hard to recover from that in terms of humiliation and in terms of your self-respect and confidence, and they all add to the difficulties of making full recoveries.

Where I work there was no knowledge of my mental health history when I had my first episode. The company was very accommodating, not only that but when I came back to work there were no barriers put in my way for development as a design engineer, and I get great support still from my company, I really do.

I think also I have enormous support from my wife. She is the main spotter in my life. She will see things where other people won't see them and she will even disagree with the medics, and always turn out to be right. There are very few marriages that survive manic depression.

Just before going back to work after that last episode, she said to me, 'Would you consider beekeeping? And since then it's been a huge thing and I've become a woodworker, I've been making my hives, I've been preparing the area, I've become a planter of flowers and herbs, which I never had an interest in before. It has just transformed things in a beautiful way, and it was ready to be transformed in that way, our smallholding here, it was just ready for bees. And for me, for my mental health, they are with me every day, and they are an obsession but a very healthy one and one that brings great reward.

When I'm in mania of course I don't sleep. In earlier days she couldn't bear the sound of snoring, and now she would find that snoring is one of the most comforting things because it means that her husband is safe, that he's well, that he's sleeping tonight, he's not wandering, he's not going off there.