In the years between my very first meeting with my doctor and this Grand Madness, I had also used the placebo effect; if a person is ill, and they make a doctor’s appointment, studies show they often begin to feel better simply because of having the appointment. So from time to time in those intervening years, if I was feeling shaky and low, I would make an appointment with him, and let the placebo effect work, and then cancel the appointment three days before.
John Berger wrote one of the most stunning books about the life of a GP, A Fortunate Man: The Story of a Country Doctor. ‘Clearly the task of the doctor . . . is to recognize the man. If the man can begin to feel recognized . . . he may even have the chance of being happy.’ In some cases, Berger writes of Dr Sassall, ‘he faces forces which no previous explanation will exactly fit, because they depend upon the history of a patient’s particular personality. He tries to keep that personality company in its loneliness.’ This is a perfect rendition of the reason why my doctor was so curative for me. He kept me company in my loneliness. He saw me. He also saw where I was in this illness. There is a healing power in truth, sheer healing in honest appraisal, with nothing hidden, and he was candid. ‘You’re very fragile,’ he said several times; other times he variously remarked: ‘You’ve been very bad’; ‘You’ve been in dangerous territory’; ‘I’ve been very worried about you.’ Those observations made me feel unalone. He was alongside me, and truly acknowledged where I was. In Berger’s words, a good doctor does more than treat patients: he is ‘the objective witness of their lives . . . the clerk of their records’. By witnessing and then naming aloud the situation I was in, my doctor made it at once real and recoverable.
I felt he was completely on my side and also wholly present; it felt as if he brought his whole self to the appointments, and this was equalizing. My mind had cracked open, been riven, wounded, horribly exposed. If I’d had to see a doctor who was masked, defended or guarded, who played a role or who wasn’t truly present, it would have felt unfair, creating a power imbalance I would have hated. In madness, anything which increases one’s sense of weakness and vulnerability is detrimental.
My doctor also openly acknowledged medicine’s limits in dealing with the mind and yet made me feel he was not out of his depth. (Many of my friends were, and said so, and while I appreciated their honesty it left me feeling in greater danger. I was completely out of my own depth, after all.) I needed to feel I was in safe hands, and I was.
He could be funny and serious; he combined sensitivity with solidity. He was tact incarnate when he needed to be but could also apply blunt common sense. He also knew how to use the gears: when to move quickly and when to go very slowly. He simply could not have had the time he made for me: the hours, the late-running and over-flowing appointments. But he gave me – in his leisurely thoughtfulness, his unhurried manner – the impression that no time was unexpandable, no appointment unstretchable, that time and hurry and pressure and workload and speed were all a mild irrelevance which could be left in the waiting room with the forgotten umbrellas and the fluffy dinosaur. And yet the speed he used when he needed to was remarkable: first getting me on antipsychotics and later getting me to hospital when I could no longer see.
As the lead climber is just ahead of you on the mountain, so I felt he was just ahead of me in this crisis. When I was flailing around trying to force myself into recovery, impatient and angry with myself for all I could not do, he gave me wiser counsel, permission to be ill, repeatedly saying that, if I’d broken my leg, I’d have no problem accepting that I couldn’t use it properly. A broken mind takes far longer to heal. Just as importantly, when the time was right, he gave me the encouragement and, more precisely, the expectation to be well.
At one point during this whole episode, I talked to one of my nephews about my doctor. My nephew usually has the sweetest temperament, but he became exasperated with me for the first time in his life.
‘You’re talking about him like he’s a god or something. He’s not a god. He’s not a saviour. He’s just a man. He’s just a man. He’s just a man.’
Three times. The vehemence of his tone drew me up short. We are very close and he understands me well. If he was upset, I knew there was matter in it. It was only later, when I read Darian Leader’s Strictly Bipolar, that I could contextualize those feelings. Leader writes of manic-depressive patients idealizing their doctors: ‘Pages of disappointment with mental health workers and medication will almost invariably be followed by a sentence such as: “Then I met the best doctor . . .” ’ Leader surmises that ‘it is not simply the doctor or the drug that has helped her but the actual function of idealization itself.’
Quite so, I thought, reading this. There you go. It’s just a feature of being bipolar. I felt, as I did so often reading Leader’s book, a sense of comfort in comprehension of the tricks and treats played on me by this condition, and there is, in my view, no other book which gives such a succinct and accurate portrait. And, at the same time, when I came to reconsider the question whether or not my doctor was a saviour, I have to say yes, he was: he saved my life. Was he an angel for me? Absolutely. I saw his wings.
I could ‘see’ the wings of people only very rarely, but every time was when I felt they had sent their minds in flights of understanding to try to find mine. They could hear what I was saying and in turn, when they spoke, their words had the power to reach me. All of them could fluently speak a winged language, though accented according to their natures and the character of my relationship with them.
All of them had minds which were fleet, kind, exact, close and precise. Like, I cannot help thinking, Wim Wenders’s guardian angels in his film Wings of Desire, which describes a vision of a world in which we are surrounded by angels. Children see them. Angels recognize each other. Libraries are full of them.
I could see their wings when I had the strongest sense of an exchange, a commerce of comprehension which left me infinitely less lonely. When, in other words, they were being good messengers – and this is Mercury’s doing: the winged messenger bringing images of wings. Part of the intensity of my gratitude is because they were willing to cross over into my sky – to risk the different temperatures and air pressures. They also gave my psyche strength, because it seemed to me that the touch of their wings in my mind suggested that perhaps I could even follow their flight down from the savage mountain into a meadowsweet valley – that perhaps I could trust their wings when my own were broken bits of sky made of stars as brilliant as stars are useless, scattered and disconnected across a cosmos of chaos and night.
Why wings? Because we fly, we humans, all of us, in thought, imagination and empathy. Not for nothing is Psyche winged, not for flight after death but for flight before death. Perhaps the human mind’s age-old sense of angels arises from an insight of what is now called madness: the word ‘angel’ comes from the Greek angelos, meaning ‘messenger’, and in highly sensitive states the mind is quick to note the messages, hyper-alert to the transactions at the border between the outer universe of the world and the inner universe of the mind.
The idea of the angel seems the very force that drives poetry, the spirit of Orpheus, something which Charles Lamb understood, describing Coleridge as ‘an Archangel a little damaged’. Angelism (as an idea within poetry), famous in Rilke’s work, is a term said to have been coined by French philosopher Jacques Maritain, while the Portuguese scholar Eduardo Lourenço described poetic angelism as the practice of poetry where the angel stands as a metaphor for poetry itself, and for the driving force of Logos, the Word.
Wings, flight and feathers have a long association with the poet-seer tradition, so Hebrew shamans would chirrup like birds when they worked. Ireland’s chief poets traditionally wore official robes made of bird feathers; court jesters wore a feather as part of their costume; and shamans around the world wear, or carry, feathers.
Angels and messengers like the Trickster can cross the border between inner and outer, between self and other; the messenge
r can transform, shapeshift, metamorphose, play the enigmatic role, occupy the quixotic space – genie, Ariel, bird or angel – and the moments when I saw people’s wings were all when their psyches were inter-intelligent with my own, and I felt as lucky to have them around me as I would guardian angels.
‘I WANT TO DIE,’ I wrote in my notebook, in capitals of capital punishment.
It is a truth of mixed-state hypomania that you live at the poles: angels and demons, heaven and hell, levity and gravity dovetail with each other, while a sickening seesaw hurls you from one to the other. The major key becomes minor with just one chord-note altered. So it is that one moment I could be keeling over with laughter at something and then, in a delirium of pain, I could have happily driven off a cliff with a flick of the wrist, or jumped heedless as hopscotch under a fast train.
It was nearly midnight. In all senses.
It was 11 p.m. on December 21st, and I was in anguish. I wanted to read John Donne, who, incidentally, wrote the first defence of suicide to be published in English. As Donne wrote of this day, the shortest in the year, ‘’Tis the year’s midnight, and it is the day’s.’ And it was mine. It was my midnight, mind benighted by itself. My life had set. To longest night.
I had had an appointment that day with my doctor but, with Christmas intervening, I wouldn’t be able to see him for a week. The lifeline felt too insubstantial when it had to rope together days which were just too far apart. Its strength was whittled by time to a frayed thread. In that day’s appointment, I despaired of my stupidity, because my doctor was saying the same thing – the same right thing, be it said: that I would get better and needed to take the medication. But this day I couldn’t follow his leading. This day, despair flooded up in me. Suicidality engulfed me, and I began thinking seriously about doing a long-distance walk around the Welsh coast because in this flinty winter weather I could ‘fall’ off a cliff without much effort and with no explanation required. No apologia pro vita mea. This idea had been at the back of my mind for some weeks, but on this solstice night suicide tolled, hollow, low, now.
I didn’t take the medication that day. Despair and alcohol got there first, and though a couple of friends were trying to persuade me, I refused. And there it was, suicide, no longer like a tormentor outside me but inside me, coiling around my heart, manipulating my mind. I did nothing other than a kind of silent keening for an hour. And then at midnight I picked up the telephone and phoned a friend. Asleep. Another. Same. A third, and I was praying: please pick up the phone. I have a friend who is an author and journalist, a man of great kindness but also, crucially, one of those people with a willingness and ability to take charge in difficult situations and an alertness to urgency and danger. Most of all, at this moment, his words had power for me, his voice a strong authority. He could outshout the suicidal callings – and he did.
Modernity can be obsessed with people expressing their feelings, spelling out their troubles and traumas, and conventional wisdom maintains that, when people are suicidal, they need to talk to someone. But it seems to me that sometimes people who feel suicidal do not need to talk so much as to listen, because they need to hear a voice stronger than the siren voice of suicide. In the terrifying abyss of suicidality and severe depression, what a person may need is not a listening ear as much as a speaking voice, talking from a place of wellness, clarity, strength and confidence: life coming towards you. Someone whose voice can reach you when you are the pelican in the wilderness, ugly, inept, unwordable, silent except for those gut-croak cries for help.
– What about your nephews who you love so much? my friend asked. Your brothers? (One of my brothers, in America, who hadn’t known about my suicidal feelings, rang me the following day and told me that on that same night he’d had his first ever suicide nightmare; something alien was ripping his guts out.)
– What about your friends who love you? You don’t have the right to cause us such pain, he said.
More than anything, he appealed to my writing self.
– Your work needs you, he said.
I had been trying to explain to him that I didn’t want to take medication because it would interfere with the glorious glimpses from the tops of the mountain, the sense that I could reach something of the mind’s deeper insights if I only had the courage to stay in the mountain ranges.
– So you’re doing this for your writing? he asked, double-checking.
– Um, yes, I said lamely.
– And how will you write if you’re dead? I mean, forgive me for stating the obvious, but this is more than illogical.
It was, of course, mad.
He used a term I’d never heard him use before. Staying alive, he said, is a sacred duty. Then slowly, carefully, calmly and kindly, he simply told me what to do, utterly practical, in that voice stronger than the suicide voice. He told me to take the medication while he stayed on the phone. I did. He told me to find my cats and get them tucked up in bed with me. He told me to go to sleep and he’d call in the morning. He has my gratitude for life.
The figures for suicide in hypomanic mixed states are appalling. Twenty per cent. One in five. You feel low enough to want to and manic enough actually to have the energy. Being in a hypomanic mixed state carries the highest suicide risk of all mental illness.
People with manic depression are twenty times more likely to commit suicide than the rest of the population and, according to Andrew Solomon, author of The Noonday Demon, manic-depressive illness is the second-leading killer of young women. Kay Redfield Jamison notes that nearly half of those with bipolar disorder will try to kill themselves at least once and also writes that in manic depression ‘any combination of symptoms is possible, but the one most virulent for suicide is the mix of depressed mood, morbid thinking, and a “wired”, agitated level of energy.’
People with manic depression die sixteen to twenty-five years earlier than the average population. In mixed-state hypomania, a person can reel between suicide and the purest life force in minutes, as Mahler experienced, as he wrote to a friend when he was nineteen: ‘The fires of a supreme zest for living and the most gnawing desire for death alternate in my heart, sometimes in the course of a single hour. I know only one thing: I cannot go on like this . . .’
‘Shield your joyous ones,’ says the Anglican prayer. ‘It is a curious request to make of God,’ notes Kay Redfield Jamison in her book on mania, Exuberance: The Passion for Life. Shield your joyous ones: for there is a terrible vulnerability in them, the high-risk skaters on thin ice.
In mountaineering, people talk of the ‘death zone’ (over 26,000 feet, or 8,000 metres; the peak of Everest is in the death zone, for example), where there is so little oxygen that the body cannot survive for long; climbers may reach into the zone for a short time but cannot spend too much time there. It was a perfect metaphor, for in this madness my mind was running out of the oxygen of sanity. In the death zone, my judgement was awry and I clung to the Voice of Reason, which spoke through my friends and through my doctor. The Voice of Reason was, I knew rationally, the one to heed. Sometimes I could see for myself that the world was just too beautiful to leave, but the howling pain drove me to de-say myself, seeking to be unspoken and unsaid, wanting obliteration, my voice annihilated. Suicide had a surly splendour to me then: sullen as depression, magnificent as mania. In moods of depression I was de-voiced, but in manic moods suicide seemed an expression of voice, a form of communication, an act of theatre, a swansong flung to Earth. Not a ‘dead end’ but an exaggerated performance, responding to life with a corresponding electricity: death. Suicide felt like a work of art, a flourishing, vital score, a blazon fanfare at the end of a symphony.
In depression, suicidality came to me with dulled despair, but in mania it came shining. It was oddly vital and extraordinarily appealing, as if my life could speak to Life only by fucking it, Eros–Thanatos in deadly embrace. As if, through suicide, I could have sex with the elemental life force, turn myself back to carbon again so the whole
rolling life force could throw the dice for another turn.
Orgasm, of course, has been called le petit mort, the little death, as if sex contains a little seed of death. Likewise, in long cultural understanding, death contains a little seed of sex. I could be joined to Life by one stupendous death, an uproarious explosion, the eruption of a volatile volcano. Agony and ecstasy were on kissing terms; their lips hot, not to exit this individual life but to enter more deeply into Life itself, exorbitant and priceless. In manic mood, suicide seemed almost celebratory, an intoxicating temptation, an audacious, flagrant dare. It had primed me, flirted with me and thrown fizzing stars across my path. It had put the glitters on me.
In the extremis of this crisis, nothing could bear the weight of my emotions or withstand their temperature: as if fire had the weight of brute metal and my mind was a rolling ball of burning lead, and suicide was standing, like Hephaestus the blacksmith, working the boiling metal to the end-point of intensity.
Mixed-state hypomania is always on the move, it demands to go further, faster, higher, deeper; it has its eyes on the ultimate, the ultima Thule. Like fire, the more it burns, the more it will burn; it demands fuel and, if that is not freely given, the fire will grab what it wants, always onward, and in its heights as well as (more predictably) in its depths, it asks: Where to from here, except a blazing, euphoric pyre?
What surprises me most, looking back, is how mania caused a slippage in categorization. Suicide seemed as if it would be a momentary event without effect. It ceased to have import or corporeality; rather, it was a trivial, impetuous, reckless thing. Reck-less, it did not reckon; did not, and could not, count the costs. I wanted to feel disembodied, as if I could shuck off life and make my body a casualty of a casual tragedy. The casual way I thought about it frightens me now, but it was of a piece with mania’s meanings. ‘Casual’ includes in its meanings both chance and accident: and we glimpse the signature of Mercury – in the realm of chance, we’re in the territory of the Trickster.
Tristimania Page 7