Madness (21 page)

Zoë and Naava and I talk when I get home about the business of a psychiatrist. It can't hurt, they say. Oh yes it can, I think, but it's also possible that Zoë and Naava and Winsome are right– psychiatrists have the specialised knowledge and experience to best manage long term illnesses like mine. So I visit Jenny and get a referral to Martin, who works in the private sector, at one of those bright, shiny private clinics.

Martin is very contained, very measured, like he has packed his real self up and left it outside the door of his consulting room. The bit that's left is probably unshockable, and as such he is safe from the vicissitudes of his patients – our pain and our neediness. We stride or slink through his door, our eyes and our faces shouting, ‘Just fix it, please, just make it go away, just explain what the hell we're doing here – on this earth, PLEASE.' And he does none of these things of course, he sits and waits and lets us pour ourselves out like vomit on the floor and we sit in it, mired in our own filth, and then we have only half an hour to swallow it all up inside ourselves and somehow get to our feet and walk like normal people back out into the world.

Winsome and I continue the discussion about illness and wellness, and reflect on the tension between reality, rationality and the world of madness.

‘For so long death has been the only salvation. That's hard to reconcile,' I say. ‘I'm really . . . just plain sad that I've been unwell for . . . how long? Fifteen years. There have been times of reprieve but the longest they've ever lasted until now is eighteen months.'

‘Psychology is a forensic process in a way,' Winsome says. ‘Requiring the development of several hypotheses that can be tested over time.'

‘Yeah, I see how that works.'

‘It took a long time for me to understand, at least in part, what was going on inside your head.'

‘I'm sorry.'

‘Not at all. In the beginning our work was about me containing you in a non-judgmental space for day-to-day problem solving and crisis management.'

‘Yes.'

‘Because it is impossible to engage in the deep and complex process of any other kind of therapy when you are acutely unwell.' She pauses. ‘Now you know that the mental illness is only one part of you; it is not the whole of you.'

‘You think?'

‘I'll say it again. The mental illness is only one part of you; it is not the whole of you. And mental illness can be managed.'

I look at her.

‘When you were sixteen the crazy stuff started and all your energy went into managing that and there was nothing left to establish a normal and integrated sense of self. It was fifteen years of total chaos really, wasn't it?'

‘Yes,' I put my head in my hands.

‘Fifteen years of dysfunctional thinking . . .'

‘Yes.' Muffled.

‘Dread and terror and blackness . . .'

‘Yes.'

‘Avowed self-loathing . . .'

‘Yes.'

‘None of which was logical in any way.'

I look up. Winsome looks at me.

‘None of which was logical in any way. ‘

She pauses.

‘What is going to keep you well, Kate?'

‘Balance,' I say.

Martin and I meet monthly. He doesn't say much. We both maintain a kind of professional reserve. I'm afraid of Martin. He has the power to lock me up, to deprive me of liberty and independence. He has the power to say, ‘Kate is mad.' And if he does so, people will believe him. Certifying someone under the Mental Health Act is a last resort to enable the person to receive necessary treatment. Nevertheless, it is an extraordinary power. Hence the importance of human connection between psychiatrist and patient that transcends a discussion of symptoms of illness and medication.

‘I'd like to read you something,' I say to Martin.

He nods.

‘This is the weaving of human living: of whose fabric each individual is a part, and of all parts of this fabric, each is intimately connected with the bottom and the extremest reach of time, each is composed of substances identical with the substance of all that surrounds, both the common objects of our disregard, and the hot centres of the stars. James Agee, New York, 1941.' My hands shake, holding the book. Eyes, tears. Unsheathed.

‘Very nice,' Martin says. ‘How much lithium are you taking?'

‘500 mg morning and night. As prescribed. Sir.'

‘Any symptoms of psychosis?' he asks.

‘No.' I smile.

He doesn't smile back. On his bookshelf are six volumes of Sigmund Freud and various psychiatric texts on mood disorders, anxiety, addictions, relationships and therapy.

‘I haven't decided yet, exactly where you fit in the way of diagnosis,' he says.

‘In my humble opinion, the brain is way more complex than your international classifications and diagnostic manuals. Have you read this?' I hold up a copy of Toni Morrison's
Beloved
.

‘No,' he says.

I sigh. ‘It's only one of the best psychological studies of family relationships ever written, never mind the cultural context. All the souls of the world are in here.' I give him my eyes again but he turns away.

‘See you in a month,' he says, walking to the door.

Within the month I develop akathisia – a feeling of inner restlessness, an intense compulsion to move, walking or pacing or rocking from one foot to the other. I can't sit down without continually crossing and uncrossing my legs and I can't grip a pen or write a sentence or hold a coffee cup because of the associated tremor in my hands and arms. The exact cause of akathisia is unknown, but it is associated with the older anti-psychotics like Pericyazine.

There are other, more serious side effects of these drugs. Muscle rigidity and slowness of movement are common. Tardive dyskinesia can be mistaken for cerebral palsy or spasticity or intellectual disability. It occurs most often in older people who are on long-term therapy. It's a syndrome of involuntary movements: protrusion of the tongue, puffing of the cheeks, puckering of the mouth and chewing. Tardive dyskinesia is usually persistent and irreversible and there is no known treatment.

So Martin suggests seroquel – one of the atypical anti-psychotics now known to be effective for people living with schizophrenia and bipolar mood disorder. To my relief, the transition from one drug to the other is uneventful. The akathisia resolves and the only side effects from the seroquel are dizziness and morning drowsiness. To get out of bed on time for work, I set three different alarms in three different rooms.

Leonardo da Vinci said, ‘Painting declines when aloof from nature.' I wonder if wellbeing and spirit do too, and so to find some space and time in which to think, I pack the tent and sleeping bag and food for a week and take some leave from work and drive to the Mt Buffalo National Park. Mt Buffalo is alpine country: pink granite, montane forests, woodland, grassy plains and sphagnum moss in bogs. Bushfires roared through last year and skeletonised most of the snow gums; their once beautiful branches are white and cold. Though everything above ground died, the tree roots survived, and new leaves are feathering up the trunks and lower branches – leaves with blue veins and burnt umber seedpods hanging pendulous as breasts, their tiny black seeds shine like patent leather in the sun.

Out on Wild Dog Plain tors and garlands of granite worn by ice and snow and rain open out into meadows of purple and white flowers. The wind breathes through the tall alpine grass shh shh and as it passes my ears, it sounds a little like arterial blood.

Sex is abundant here. Down low in the undergrowth are paired crickets, beetles and ants, sleek lizards and even the abandoned exoskeletons of cicadas, translucent in the sun. Caterpillars are piled one upon another, devouring leaves. I walk with my mouth slightly open, grinning, and swallow a fly, eeee in the back of my throat. Full-bodied dragonflies flit-start-hover over Dickson's Creek, whose water is here weighed down with algae, further on clear as air. Under the shade of a regenerating snow gum I crouch to the level of everlasting daisies, some great white puffballs of seeds – white parachutes.

The first night is perfect.

The second night is perfect.

The third evening long shadows embrace the grass, swooping through trees, sucking the green. Shadows etch themselves into the ochre pitch of leaves, lengthening into vermilion, blazing against arc cold. My fingers glisten and swerve in leaf-light. I'm cold too. I try wrapping myself around a salmon gum to touch its heat and to kiss its lips as one who is deaf and loving. We glimmer fantastically.

The fourth night the Wandjina come – Kimberley country cloud and rain spirits. Somehow they sneak under my eyelids and even when my eyes are closed, they're . . . staring. They never blink. I sit in the car and listen to the BBC World Service and accidentally catch my reflection in the rearview mirror. Then I'm in the mirror, looking out of the mirror at my reflection. I pack up food and clothes and tent and drive home through the night and in the morning I make an appointment with Martin.

‘So,' he says. ‘How are you?'

‘Oh, a bit weird, intense weird. Very intense weird.'

‘What's happening?'

‘I've been having visions of spirit people.'

Martin raises his eyebrows. ‘Spirit people,' he says.

‘Yes. They have black staring eyes or red staring eyes and noses but no mouths. There's a particular Aboriginal name for them but I'm not going to say it out of respect.'

‘How many hours of sleep are you getting?'

‘Four or five. Depends on what's going on in the night.'

‘What's going on in the night?'

‘Night-terrors. Nightmares. So I'm teaching myself about surrealism, you know, in art and photography and dream theory and psychology. It's complex, the unconscious and the subconscious – I'm learning instead of sleeping.'

‘How's work?'

‘What?'

‘Work.'

‘Oh. Not much in the way of surrealism.'

‘Are you still on 300 mg of venlafaxine?'

‘Yep.'

‘I'd like to reduce the dose.'

‘D'you think? I don't know. Intensity of feeling isn't necessarily pathological. Ecstasy may be . . . then again, isn't religious ecstasy considered a higher state of being? Communion with God and enlightenment and all that? If you were a Sufi teacher instead of a psychiatrist, you'd be, I don't know . . . delighted that I'm reaching out to a kind of divine presence.'

Martin leans back in his chair and clasps his hands and looks at me levelly.

‘You make things difficult,' he says.

I tense, tense . . . then slacken and sigh and say, ‘Okay, what dose?'

‘150 mg for a week and we'll review.'

The major mental illnesses – schizophrenia, bipolar disorder and major depression – are biological illnesses. The symptoms result from neurochemical imbalances in the brain. The cause of the neurochemical imbalances is multifactorial: genetics, brain structure, personality, social environment, vulnerability to stress.

Antipsychotic medication, taken consistently, reduces the risk of relapse in individuals with psychosis from 70 per cent to 30 per cent. Antidepressants reduce the risk of depressive relapse by about two thirds. There is a link between psychosocial adversity (major life events and day-to-day difficulties) and illness relapse, but adversity and stress are not sole causal factors. The same applies for use of alcohol and drugs like marijuana and amphetamines.

So, even if we do everything ‘right,' if we take our medication, work on cognitive change and behaviour change in therapy, if we manage stress and live reasonably healthily, we still have about a 30 per cent chance of relapse into acute illness.

And sometimes it is hard to identify the early warning signs of relapse, particularly those of hypomania because they're commonly pleasurable – the buzz, the rush of sensory inputs, the energy and euphoria. Sometimes it's like being swept out to sea when you're swept incrementally further out with each wave and you only become aware of how far out you are when you're dangerously distant from the shore.

Martin's office to home is a two-hour walk. Perfect for mulling things over, for reflection. Am I ill? Am I am I . . . I am? Fuck no. No way. Possibly.

‘Right,' I say to self. ‘Slow down. Think. Deal. What matters?'

There are multi-dimensional consequences of a major relapse – for me and for the people I love and for the people I work with and for the wider community (the costs of hospitalisation). At our regular Saturday night dinner, I say to Zoë and Naava, ‘Can I flag something with you?'

‘Sure,' they say.

‘The thing is . . . for no particular reason . . . everything is kinda intense weird . . . as if god has turned up sound and saturation and contrast. And the nightmares are back. A lot of blood. I think I've been talking too fast. Last night I was trying to explain to Deborah how some numbers are beautiful, like 8, and others are awkward, like 7, and others are mournful, like 9. She really didn't get it. Is that weird?'