Madness

This memoir relies on the many volumes of notes, observations, conversations, odd phrases and sudden ideas written during episodes of illness and transcribed here unedited. It also relies on memory, which is commonly subjective and fragile, and on the notes of treating clinicians. The events took place over a period of about fifteen years. In the interests of telling a story, time is on occasion expanded and on occasion compressed.

The names of individuals (and in some cases their gender and physical appearance) have been altered to preserve anonymity except where permission has been granted.

Madness is a real world for the many thousands of people who are right now living within it and dying within it. It never apologises. Sometimes it is a shadow, ever present, without regard for the sun. Sometimes it is a well of dark water with no bottom, or a levitation device to the stars. It takes away the rational minds of ordinary people. It takes our hearts, knowing death so well. This world was once my pair of horns, my pair of wings. Now we regard each other with caution and, yes, healthy respect. Both bruised but very much alive.

This book is for everyone living within this world, for everyone touched by this world, and for everyone seeking to further his or her understanding of it, whether you think of madness as a biological illness of the brain or an understandable part of the continuum of the human condition. Either way, we – the people who inhabit this world – are in every other respect just like you. We want to live well.

Flirting. With burning, injecting, infection, ash, caustic soda and perfume. Eyes, dry and hot, lie heavy in their bony sockets. I am going to cut off my right arm. This is an operation like any other, with the exception of anaesthesia. I have procured a surgeon's scalpel, a stitch cutter, a chef's knife, surgical scissors, tweezers, needle and syringe.

A third of the way down from my shoulder to elbow the scalpel slides over and into my white skin, dimly freckled and smooth as mango. Skin is surprisingly recalcitrant. The part of my mind that is consciousness has folded itself away. I am blank. The scalpel finds the deepest skin, the dermis, the little yellow pillows of fat like pearls. Bluish-red bloodlines seep down my right arm, over my right breast.

It is true that blood is thicker than water. Blood doesn't run in the way of water. It is glutinous, it has a richness. As a symbol, is inextricably linked to the colour red. It lies at the end of a series that begins with sunlight and yellow-gold. It is the perfect symbol of animate life, of passion, of sacrifice.

Getting up, I go and look at the arm in the mirror, I breathe awkwardly; my heartbeat is awkward in my ears. The sky in the mirror is grey with patchy clouds and a low red sun. My cat sits on the bed impassively. I breathe in more than air. There is an exquisite burning, prickling pain in my head and down the right side of my body. The stitch cutter is useful for usurping bits of fibrous connective tissue that bind the body together. I cut deeper and widen the wound with the surgical scissors. Blood is running thickly, clotting in warm lumps along my arm, inching along cracks in the floorboards.

My hands are both shaking so I enclose the bad hand in the good hand for a moment, hold them, then press the scalpel in deeper. The wind has picked up, it is quite dark, the corners of the room are looming into the wider space with their quiet cream plaster, everything is suddenly round and small and I am breathing low, long breaths with a kind of rasp at the end – more than a sigh, less than a wail. This is a private relationship – me and the air and the room and the scalpel in my hands, the blood at my feet. But I can't get further than the pure blue-white of bone – there is too much red, the smell of acetic acid and warmed metal, the redundant tissue, and my fingers have gone quite cold. I leave the instruments on the floor and wrap up my arm in a blue bath towel. The other people who live in my head – the ones who bicker and sneer and cajole and scream – they are at last still. Atonement, I think, appeasement. A little death.

It is 3 a.m. the morning after. Outside the local hospital the wind is brisk and the lights fluorescent. Cars whip by; flashes in the night. The Emergency Department waiting room is small; a sign above the main desk says Triage Nurse. I sit down and wait. A young man arrives behind the desk, sits, looks at the chart in front of him, makes a phone call, taps into the computer. Then he says, ‘Can I help you?'

‘I tried to cut off my arm.'

‘Pardon?'

‘My arm . . .' Blood is a blush through my shirt.

‘How did this happen?'

‘I tried to cut it off.'

‘When?'

‘Last night.'

‘Oh.' Then, ‘Why did you wait so long to come in?' I shrug my one good shoulder and stare at the linoleum floor.

The triage area looks out across the road and the tram tracks to a large park, whose closest trees are lit yellow-white by the hospital lights. The sky backs black and voluminous. My head has left my body and is floating somewhere just below a corner of the roof.

Deeper inside the Emergency Department the smell is a mixture of urine and bleach and something I can't define. I take my clothes off and am left alone in a white cotton gown. The cubicle has pink curtains. I doze briefly. People are paged, IV pumps bleep, the air ambulance phone rings into the night. I lie and think and poke at my thick hot arm. The Plastics Registrar, a small man with slick black hair and pinstriped pants, decides on surgery. ‘Now,' he says, white coat tails disappearing down the white corridor. He has left the towels in a darkly red pile in the corner of the room. My arm leers open, a hopeless mix of skin, muscle fibre and the pearlescent globs of fat. Blood seeps thickly.

The anaesthetics registrar is kind. She takes my good hand and smiles. I'm flooded with something like relief and then confusion. After surgery I wake in a hospital bed with my arm strapped down at my side. An IV line runs delicately from my other arm into a bag of normal saline above my head. It is connected to a blue pump that has flashing yellow numbers on its front and bleeps and whines periodically; it is talking. The curtains are open and outside the dark is not black, rather a dull orange brown. It is cool and quiet and ordered and I feel like oozing through the bed and the floor and out into the night.

‘Patient Controlled Analgesia,' says the nurse, patting an electronic pad on my left. ‘Morphine.' I press the button. There is a whoosh along my veins from finger tips to heart, which flutters, I have several orgasms, I'm as relaxed as it is possible to be, suddenly the sky above is very blue – there are no clouds.

Later a surgical resident stands at the end of the bed in a perfect blue suit, a continuation of the sky. ‘We've sewn up the biceps muscle belly and the triceps tendons. You missed the brachial artery; otherwise you probably wouldn't be here. The plaster cast needs to stay on for four weeks to let everything heal. We won't know whether you've lost any function until we take it off. Exercising your fingers is fine.'

I sit up. There appears to be a camera in the overhead light and another one in the air conditioning vent. This is some kind of test. My fingers are bright orange from the iodine pre-surgical wash. They aren't connected to me at all. The rest of my arm up to the shoulder is immobilised by a plaster cast curved at the elbow and covered with a bandage and tape. I can't go to the toilet with the cameras in the room and the pain from my bladder radiates.

This killing is a killing of part of the self. Removing an arm, removing a symbolic tumour, severing something unnatural. I know. I know how to get the rotten bits out, under the stone-eyed stare of the people in my head. They are a little like God. Greater. Stronger. Wiser.

Two security guards flank the wheelchair while a nurse from the surgical ward wheels me along the shiny linoleum from the main hospital to Psychiatry. There is no caffeine in the High Dependency Unit. Cigarettes are regulated, lighters not allowed. HDU is five rooms locked off from the rest of the ward. My shoelaces, belt, toothbrush, shampoo, razor, tweezers, pens and deodorant have been taken away. Later they take my glasses. All of my senses are in chaos. I am a firefly without luciferase: instead of luminescence there is a dark that is engulfing and at the same time vacuous. I cannot see more than half a metre in front of my face; after that there is a joyous amalgam of colour and some vague suggestion of form.

No, I'm okay, I can't breathe. I ask staff to let me sleep in the main room where I can see other people. They refuse. I ask for more Largactil. They bring me 100 mg, which I take with a swig of fake coffee. I can't cry, but there is a howl lurking somewhere between my stomach and my diaphragm. The stitched up right arm throbs dully in its casing.

After the morning staff meeting the psych registrar calls me into an interview room where I meet the consultant psychiatrist and Lisa B, my contact nurse. The consultant conducts the interview, the registrar takes notes in a corner, Lisa sits next to me on the couch.

‘How are you?' asks the consultant. I curl up, knees under my chin, then hold my hands out, palms upward and shrug. My hands shake. ‘How are you,' is too enormous a question, there are too many possibilities, it is too vast a chasm to cross.

‘How do you feel about being here?'

‘Confused.'

‘Why?'

‘I should be dead.' The registrar writes that down.

‘Why should you be dead, Kate?'

‘It is the process of natural selection, it's in my DNA. I was born wrong.' No one appears to understand.

At lunch, beef stroganoff, carrots and beans, I meet a fellow patient with multicoloured layers of cloth winding up his wrists to his biceps and CARPE DIEM tattooed around the base of his neck in red and black. He smiles with his eyes as well as his mouth.

‘I feel like jumping out of my skin every day of the week,' he says. His smile is infectious and his t-shirt reads ‘Kill Your TV'.

‘I'm not so flamboyant anymore. Now that I've got my head together, because before I used to be the prime minister you know but I had to resign. Are you smart? I am, but I have to be careful because it's likely that if they find out they'll be on to me, know what I mean? Bottom line is, I'm in disguise.'

I'm watching everyone from behind a glass wall, I am walking through treacle. Staff restrict my visitors until I take a shower. I can't see the point. They'll insist I do it all over again tomorrow.

Not even sleep is safe. This particular night a man is standing at the end of my bed with a knife. He has tied me on my back with scratchy white rope. He stands quite still in the dark. I can tell when he is blinking; I can see his sclerae. Cloth of some kind is forced down my throat. I stop breathing. There is flint and fumes and spirals of fluff in my throat, someone is caressing my neck. I stop breathing.

Usually I drown the dreams with wine, vodka, bourbon, anything. When alcohol is not enough, I add benzos: temazepam, mogadon, rivotril, and when they don't work, I throw in analgesics: codeine, doxylamine, tramadol, and finish up with the antihistamines: phenergan, chlorpheniramine. I lie in an absurd stupor for hours, but the dreams become smaller – flashes of violence in the night – a tight, concrete stairwell, a push in the small of the back, the falling, black and grey. At 3 a.m. my mouth is wide-open, tongue dry as sand, hands in fists.

Someone is pacing and angry. Someone else is out cold on the floor. Staff wake him up and march him to his room. He's shuffling terribly. I watch from the corner, my back to the cool walls.

There's a flash of colour across my eyes, a fist.

There's movement and shouting inside my head.

I sit absolutely still; I don't blink. Later I go into my cubicle and pull a long black sock out of a drawer and lie down on the prickly carpet that has a large stain in the centre and tie the sock around my neck with the ends facing front and I pull down hard on the ends and my ears are suddenly full of white noise, I'm sweating, I feel very light like I'm swaying in a easy breeze, I pull down harder and my head is quiet, I am suddenly tender, I wonder if I'm smiling, there is a Code Blue being called somewhere – somewhere someone's heart has stopped beating in between the cold and the air and the stretch of consciousness called reason.