Stopping Suicide and Neoliberalism

I’ve been frustrated, to say the very least, to see the seemingly endless tweets this last week following two or three (depending on which twittersphere you live in) high profile suicides. There was Anthony Bourdain, Kate Spade, and for those of us in academia, the one that cut closest to the bone, Malcolm Anderson.

The ‘answers’ to the desperately sad end to these human lives have fallen into one of two categories; 1: they should have asked for help, or 2: their friends and family should have done more to help

Here’s the problem with both these solutions: it insists this is a personal problem and not a social problem. It is, in effect, a neoliberal solution. Neoliberalism posits that individual success or failure is down to the individual. You’re poor? Didn’t work hard enough. You’re fat? Didn’t exert enough self-control. Social, structural factors do not get a look in*.

Why is this relevant to the tweets and recommendations offered? All those ‘solutions’ propose that if friends just “check in” a little more, people won’t kill themselves, won’t feel worthless, alone, isolated.  If people ‘ask for help’ and ‘tell someone’ they are feeling suicidal they will be saved! and somehow those feelings will magically be resolved by virtue of sharing them and their friends offering…who knows what.

By contrast: a response to an increasing suicide rate, and suicides of people who work in high pressured work environments, which accounts for the social conditions we share, which considers the health care environment we’re living with, which acknowledges social welfare arrangements and the role of the state? That response says we need fully funded mental health services. It says we need proper social care, social services, addiction support. It says we need to totally destroy the institutional, neoliberal, working cultures which profit from our anxiety. We need to end the cultures which say “work until you break, then we fire you and hire the next person in line, who is desperate for any work no matter how exploitative and insecure**”

I am not a psychiatrist. I am not a crisis team. I am not a therapist. I am not a GP who can prescribe medication. Why do the solutions circulating on twitter lately suggest I have all of those skills and more and can save my friends from suicide?

Nobody expects that I should have been able to save my friends dying from cystic fibrosis, breast cancer, or recurrent brain tumours. Yet I am expected to have saved my friends from dying from their chronic mental health issues?

There’s also a presumption that everyone who is suicidal fits a fairly narrow image of the depressed but totally loveable waif. People who are suicidal are sometimes long-term ill and isolated from friends and family. They may have addiction issues which mean friends and family can no longer intervene in protection of their own health and wellbeing. They may be psychotic or manic and entirely out of touch with reality. People who take their own lives may not show any warning signs, they may not exhibit a single ‘symptom’. People die on impulse, in desperation, and by accident as part of an action which was intended to be harmful but not fatal.

More than this – there’s a suggestion people who died from poor mental health didn’t ask for help. This magical catch all phrase which twitter seems sure is the cure to all. They do. They did. They are right now. But when we look bigger, when we look structural and social we can see that a) asking for help doesn’t mean you’ll receive appropriate or useful help, as my own experiences testify and b) asking for help can risk more, so much more. Why didn’t Malcolm Anderson ‘ask for help’? He probably did, but the work culture meant asking more than once, or even twice, would be unacceptable and risk his position and pay. And if there are no mental health services? If you have been labelled ‘attention seeking’ and are refused crisis care or referral?

The crisis of suicide is not an individual problem. It will not be solved by leaving your friend a voice mail message saying you “miss them and care about you and hope you feel better soon” (although that doesn’t hurt). It won’t be solved by simply saying, to the universe “help me”, because when there is a global toxic work environment which isn’t going to change around your pain, or when there are no specialist medical services to address your needs, that’s no better than saying nothing.

We are not the part of this that needs solving. We did not kill our friends and family through neglect of care or love. We are not individually responsible for everyone who falls off the edge. We are doing ok, collectively. We’re doing the best we can, individually. It’s the system that needs to change.

 

* This is a good, plain language piece if you’d like to read more on this idea of neoliberalism and the self. https://www.huffingtonpost.com/robert-kuang/the-neoliberal-trap-of-th_b_9751594.html?guccounter=1

** My experiences are included in this article after my union put the journalist in touch with me.

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Not so manic now?

I’ve been having a….time.

After a really dreadful summer last year, I was pretty much on an even keel. Had a hard November/December but that was mostly just work induced exhaustion which was resolved with a well timed holiday. Went into the new year – and new term at work with a lot of energy and optimism. But I’ve felt like my bucket of joy has a hole in the bottom for a few months now. As soon as I fill it up it seems to be half empty again.

After a wretched few weeks of the most acute anxiety I have ever experienced for such a prolonged period I managed to arrange an appointment to speak to my GP (a challenge in itself when you are struggling to process the most simple of task and panic at any unexpected occurance). We agreed that I should try some medication again so I am going on a low dose of Trazodone, something I haven’t tried before. I’ve been putting off starting for a month because of my worries about the side effects. And then I felt ok at the beginning of this week but today I realised that, yes, I need to commit to trying it. If that doesn’t work the GP suggests he will review the waiting list to see a psychiatrist and we can decide whether it’s worth waiting, or if he can write to psychiatrist for advice and prescribe to me in primary care what would normally only be allowed in secondary care.

One thing he sort of threw out there was the suggestion that the diagnosis of cyclothymia may not be the right one – or at least not the one which actually opens options to me to get what I need. He, rightly, pointed out that there is so much overlap between criteria for different diagnoses that it’s not really a science so much as a fitting – does this diagnosis provide a way to treat and help this person? No. What else?

I’m open to revisiting the diagnosis, but it did remind me how hard I find it to speak out loud about the most troubling symptoms. I have written about some of them here, and I often report them to friends when I am experiencing them. But cold, in an office? It’s difficult to lose face in that way – here is a load of undignified, nonsensical stuff that happens in my head sometimes.  I am afraid of being laughed at. I am afraid of being dismissed, or talked down to, or not believed. I am afraid of being feared or a source of disgust.

And in all of it, I can never turn off the voice that’s saying “you’re making it all up. You’re doing it for attention. Just pull yourself together and stop being so self indulgent”. I can hardly report symptoms I could get rid of if only I gave myself a good talking to, now can I?

Either way, the 8 year med-free cyclothymia experiment is over.

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Where Are We Now?

I think the time since the last update might be the longest I’ve gone between posts. There both are and are not reasons for this.

One big factor has been work. Work has been both rewarding and exhausting. I’ve had no time to post, and no mental energy left – which is sometimes good, it can be nice to feel spent and have no time or inclination for unproductive introspection.

In terms of work, most recently, my union called 14 days of strike action spread over 4 weeks. Due to my participation in the strike, work has transformed from a good balance of exhausting and rewarding, to a source of anxiety, frustrated productivity, and stress.

This post isn’t about the reasons for the strike action, it’s about the personal, emotional experience of taking part in prolonged and ongoing strike action. And, I think, it might be about being in my mid-30s and not feeling I have much direction.

I’ve written before about my slightly complicated relationship to work, it’s where my sense of self worth and fulfilment comes from. It’s the only place I get that from. Not being able to work -deliberately withdrawing my labour – means denying myself a regulating, rewarding element from my life. And it takes it’s toll on my mental wellbeing.

When I’m working sometimes I can’t get out of bed in the morning, I can’t sleep, I feel frustrated and I feel overloaded and I need to be able to work flexibly because sometimes I have very poor concentration and anxiety. It’s important to note that all those things are present whether I’m in work or not. However, what I lose during the strike (and during holidays where I don’t have an actual trip-away of some sort planned) is the focus, the impetus to keep moving, and the sense of connection to some sort of purpose.

If I don’t have the next deadline to drive me forward, if I don’t have a place to go to structure my day and move me from one headspace (home – neurosis) to another (work – purpose) I don’t get that sense of worth.

And right now, as more friends settle down, as more friends move forward with home purchases or children or deepening and developing relationships, it’s harder to find reasons to celebrate or be happy with who I am by reference to who I am as in individual – who I am on a personal level. Nobody wants me on an inter-personal level, so I need to prove my value professionally.

And now I can’t do that. Worse; I have to stop working in order to try and protect my retirement income. So not only am I refusing to work, I’m doing it as an investment in a future life I literally cannot imagine. And not just in a millenial, I’m-never-going-to-retire, way. I mean in terms of not being able to imagine my life in retirement as anything other than cripplingly lonely, with no value as a person, with no purpose. And still mad.

Being mad, as you get older, is harder. I have less tolerance for it in myself and others. I see the frequency of mental health problems and neuroses in my peers. I hear people talking about it. And I don’t – can’t – won’t?- accept it.

This is not what I imagined or expected or hoped my life would be like ‘in the future’ [forever deferred, non-specified future that is]. I don’t want us to have to spend all this energy on looking after each other. I’m fed up of seeing people drop off the edge without warning. I hate realising we won’t just ‘grow out’ of the pain and trauma which shaped us at different points in our past. I am exhausted by all of our struggles.

I feel hopeless, drained, to come to the realisation that this is life. This isn’t the stuff we sort out before we get on with life. This is it. It’s woven into the fabric of our everyday. There are so many memes about adulthood being defined by feeling constantly exhausted. I think it’s possible to read that simply as physical exhaustion – but it’s also a psychic exhaustion.

And I want to bury my head in work and avoid all of this. ‘This’ being pain and messy emotions and crap coping strategies and uncertain future. But, of course, I can’t.

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Boring

Being mad is, above all other things, boring.

Same cycling moods. Same paranoia. Same neurosis. Same self-harm. Same rambling, irrational verbalisations of the experience.

The whole “just ask for help”, the “if you want to talk, I’ll always be here” thing. It’s all…difficult in the face of that.

“Help! I’m in crisis! Admittedly…it is the same crisis I was in 3 months ago. And I’ll say the same things I did then. And so will you. And it’ll pass, like it did last time but…”

How can I pierce through my friend’s Saturday nights – good, bad, indifferent as they may be – to ask them to keep me company through this most familiar, most urgent but also most recurrent mood?

Yes, I’ll self harm. But in the scheme of things, does that really matter? Is my non-permanent self-damage really more significant than their comfortable night in, or night out, or early night? Of course it isn’t.  And why at 30-mumble-mumble years old am I still incapable of actually taking responsibility for myself on that front?

Why can’t I heal myself? Why can’t I care for myself in a manner which doesn’t shape my clothing choices for the next 3-4 weeks? Why am I so incapable of managing my own moods that I have the option of being “the crazy, exhausting, always something wrong” friend or the “distant, so fun, really hard to pin down” friend who definitely never reveals any of this?

Why can’t I be a whole person?

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Limitations

I grew up, like so many people my age, being told we could be anything, achieve anything if we only set our minds to it.

My parents are the result of post war baby boom. The world changed beyond recognition in their lifetime. They built me up to more than they ever imagined for themselves and they did it in good faith. They are a generation of optimists.

We, at the top end of the “millennial” generation, have come to terms with the idea we’re going to have lower social mobility than our parents. We’ve come to terms with the idea that we can enjoy avocado on toast but not ever get a mortgage.  We’re more educated but underemployed and living on temporary and zero hour contracts.

We get to do that collectively.

What I don’t get to do collectively, is come to terms with the other limitations I never expected. The limitations which no amount of work, witty think pieces, or economic change will alter.

Tonight this came, unexpectedly, into focus, when I watched a BBC 2 show called “Astronauts: Do You Have What it Takes?”

When I was a kid I wanted to either be an astronaut or a vet. My maths and biology was atrocious during my A Levels because I was a neurotic, mentalist wreck and busy taking lots of drugs so I never applied to any veterinary university programmes. But I know the route to being an astronaut can be much more circuitous, so I never really, truly let go of that dream. I’ve never pursued it, but it has lived as a pleasant daydream at the back of my head.

Cyclothymics in Space! is not a series we’re going to see anytime soon. Our unique talents don’t really tally.  What can I bring to the ISS? Moods which expand beyond self discipline, a tendency to paranoia, lingering trauma and grudges which primarily exist in the mind and not objective reality. Emotions which happen for no damn reason. Fluctuating energy levels, distrust, clouded reasoning, blurry recall, hyper sexuality.

These are antithetical to being an astronaut.

Lots of people are unsuited to being astronauts. People with physical disabilities, people with chronic physical health conditions, people with colour blindness, deaf people, blind people, claustrophobics…the list goes on and on.

But tonight it was realising I would be ruled out at the first personality and emotional evaluation test stage which made me feel utterly defeated.

We all want to be limitless. Our limits happen in different places and at different times. Sometimes it’s unexpected places we find them, places or things we didn’t even know we still had an emotional connection to (like being an astronaut) and that’s when it can really trip you up.

No mortgage, no stint on the ISS. I’ve got avocado on toast, what is the consolation prize for not being able to be an astronaut?

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The lights are off

Yesterday I couldn’t function.

This is perhaps not the most shocking of revelations. This entire blog is dedicated to the times my mood and brain knock me on my arse in one way or another.

But yesterday was awful for how absolute it was.

If I am a house – my brain is a house – with a kitchen and bathroom, living room, perhaps a study, and a couple of bedrooms, then yesterday was a power cut. Normally the house is alive, sometimes all the rooms are lit and full of noise and life, other times there are just one or two lights on. Perhaps something is slowly roasting in the oven for dinner.  There is life there.  A low hum of power and possibility, snaking through the whole building.

Yesterday was a catastrophic power cut.

Everything went off. Absolutely no sign of life from the outside and the very function of the house almost entirely wiped out. And I was just huddled in the corner of a room, waiting for power to be restored.

Today I found a camping gas stove and, whilst still huddled, have found a little light and warmth to pass the day with.

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Being chased down

There’s not much worse than knowing a low is coming and throwing all your energy at trying to avoid it.

At a glance, it might seem like the low itself is the worst part. But in the midst of a low, there is only the low. No real belief there was a before, very little faith there will be an after. It is, as Sylvia Plath so memorably termed it, a bell jar. Suffocating, inescapable, sealed. Not desirable, by any stretch – but it demands and enforces absolute immediacy in your relationship to it.

By contrast, the period before a low comes crashing down is marked, for me, by panic as I try and rearrange the things I want to do, and cling desperately onto the last rays of hypomania or baseline-mood. This period is increasingly characterised by me frantically trying to hang on to the good feelings; a task as hopeless as holding water in your hands. No matter how closely you grip your fingers, it’s going to run away from you eventually.

I am a control freak. I schedule my work and life carefully; I plan social stuff months in advance, I always have a to do list. My organisation in packing and filing is legendary amongst my friends and colleagues. I completed a PhD, despite cyclothymia, through relentless planning and organising. I have the past 10 years of carefully recorded personal budgets saved in Excel. I genuinely think storage solutions, year planners, week-to-view diaries, filing and planning are fun activities or items to enjoy on a quiet afternoon.

There’s a significant degree to which I struggle to accept I can’t schedule my moods, or rearrange them to suit a larger timetable. This has been exemplified in the last week or so, in which I’ve attempted to run from this mood, with varying degrees of success.

Perhaps most foolishly, every time I manage to alleviate or defer (or perhaps I should call it ‘drown out’) the low mood on the horizon, I think I’ve cracked it. Believe I’ve finally achieved just the right combination of beta blockers, cigarettes, social activities and work.  This makes the resurfacing of the low mood all the more discouraging and distressing. I become not only depressed, but angry with myself for not being able to turn back the tide. In this context, it’s not just a low mood: it’s a failure.

Living with cyclothymia is a constant tightrope; how hard should I fight and push back against my moods? How much should I accept my mood changes and aim to work around these largely unpredictable fluctuations? When I do work to manage my mood – doing things that take me away from day-to-day stresses or actively fleeing the places and people that I associate with negative moods in favour of fantastic escape – where is the line between ‘restorative, boosting well-being and net gain’ and ‘borrowing too much energy for a short term boost’? The latter being what that I find myself facing down now, with a deep ache, a sense of loss for the mood I could not cling on to and must now live without for a while.

In terms of the length of the extremes of mood, cyclothymia is fleeting. It’s getting to the point where I spend longer running from, and dreading, and pouring energy into avoiding, these moods than I do actually living through them. And that certainly isn’t living with cyclothymia, it’s fighting an unwinnable fight. I’m just not sure if I’m too stubborn, too much of a control freak, to accept I need to let go a bit to get back some sort of control.

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High Stakes Gambling

I wrote some time ago about coming across the idea that bipolar disorder[s] is an ‘allergy to stress’ and oh boy, if that’s true then the run up to a general election, whilst working 3 jobs and having no confirmed employment after August is like bathing in peanut oil/sleeping in a hay bale/other extreme exposure to common allergen.

I have been riding some fairly extreme [within the context of cyclothymia] highs and lows this past month of two. A couple of weeks ago I had one of the most glorious, free wheeling, ‘good god have you noticed how extremely attractive I am’ periods of hypomania I’ve had in literally years. In fact, it was so pure, I began to believe I wouldn’t experience its corollary.

Of course, I was wrong.

It began to float into view last week.  Like the edges of your vision darkening, or when sea mist starts to roll in and you look to the horizon and can’t quite make out where you can normally see too, but you’re sure it used to be further.

This particular low is everything the hypomania was not. Or, more accurately, the absolute inverse of everything the hypomania was. I was confident, felt sexy and sexual, energetic, funny, articulate, optimistic; now I’m defeated, heavy, pessimistic, distracted and forgetful.  Reflections, which began in conversation with a friend, on my own [experience of] gender that had seemed so intriguing and freeing, have become an internal monologue, a weight, and a source of fear.

I started smoking again. I self harmed.

It’s hard to deal with times like this. I write, often, about the ways I try and manage my cyclothymia through my lifestyle. Generally, I try to stamp down on my impulse to really let highs run unchecked and don’t indulge them by drinking and not sleeping.

But sometimes the allure is too great, the release from the everyday is so welcome, and the energy that runs through me from head to toe is just liberating.

I can’t really eat gluten without getting a lot of pain, and getting quite sick. An NHS consultant advised me to avoid it. Every now and again though, I smell fresh bread in the supermarket, or see a particularly mouthwatering-looking cake, and I think ‘fuck it, the pain is worth it’ and I gorge myself for an afternoon, or a day. As I double over in pain the next day – or sometimes just a few hours later – I usually think “I really should stop doing this, it’s not worth it”. But then the pain subsides, I stumble back out into the world and I sort of…forget.

Stress will keep coming; there will always be something to tip me over into another hard cycle. And the option to ride the wave of unsettled mood as far as it goes will keep presenting itself to me. As long as I can survive the lows, actually hang on through them to the other side, is it really the worst thing to take that pay off from time to time?

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Just ‘doing it for attention’

I’ve been haunted by the accusation that I am ‘just doing [whatever] for attention’ since I first heard it levelled at people who self harmed, and then my fear deepened when a friend at school accused me of it in response to my not eating.

Fear of being thought of as ‘attention seeking’ as a teenager meant I hid every element of my unhappiness.  I was petrified that someone would discover my self harm and call me an attention seeker, so I painstakingly covered.  For a decade.  And I was afraid I would be called attention seeking for not eating, so even when the school nurse cautioned I was ‘under weight’ I didn’t say a word – and publicly laughed at such an absurd assessment.

The difficult thing is, I think, that these actions are attention seeking.  But bear with me: probably not quite in the way you’re thinking.

Teenagers, in particular, are going through unparalleled emotional, bodily, and cognitive/intellectual changes. Their social relationships are radically rearranging themselves as they re-orientate themselves around peers rather than family, their bodies are changing in very obvious ways in terms of puberty and hormones, but they are also changing into the shape that will likely determine how they experience much of their rest of their lives.  More than this, they are exploring increasingly intense and sometimes romantic relationships, and learning about the pleasure their bodies can achieve in consent with others. They are coming to terms with ideas like mortality, and able for the first time to take responsibility for assessing risks and gambling their own safety.

Looking back on who I was as a deeply unhappy 14-18 year old, I still don’t know how to fully articulate that experience, or how I could have communicated the sense of being lost in my own body, baffled by my new and changing emotions, isolated from my [seemingly] entirely-heterosexual surroundings, and the fear and exhilaration I was encountering as I began taking risks with drugs and alcohol.

What I can see when I look back, is a young woman trying to ask people around her to help.  I did want attention – I wanted someone to show me how to navigate that transition in my life, I wanted someone to tell me my feelings were as significant and life-altering as they felt, I wanted someone to validate the depth of the things I felt without calling me “dramatic” (another favourite accompaniment to ‘attention-seeking’). In a sea of other teenagers, all struggling to find themselves and each other, I wanted to be seen.  I needed attention that distinguished me from the crowd (‘bloody teenagers’) and reassured me I was valuable.

My heart aches for how isolated and lost I was at this time – how desperately I wanted someone to notice the physical actions I was taking to ask for help, and how entirely unable I was to do that verbally.  Ultimately, two parents of my friends, two of my best friends, and a girlfriend, helped me in the ways I needed.

Subconsciously, I think altering your body through self-harm and disordered eating are, ultimately, actions which some part of your mind knows will draw attention.  Faced with a total lack of language for those feelings, or the skills of reflection and introspection we develop into adulthood, how else can young people communicate their need for care, for guidance, for help, for attention?

As adults, we’re expected to move away from these actions, to develop different strategies, to recognise that harming ourselves as a cry for help is ’emotionally manipulative’.  As I understand it, one criteria which is used to identify and diagnose borderline personality disorder relates to ‘manipulative’ or ‘attention seeking’ behaviour and I know a number of people with symptoms/moods similar to mine who have been diagnosed with BPD, apparently largely because of their long term self harm. I also know many of these people have repeatedly sought psychiatric help, have repeatedly asked, calmly, clearly and with specific evidence of need and defined goals, for emotional support from the appropriate health care providers; and they have been turned away.  What can you do when expressing in words, in ‘acceptable’ ways, your need for help is unsuccessful?

I  know someone who works as a NHS Psychiatrist and is called to A&Es to assess people in crisis – usually at the point they are expressing suicidal impulses or engaging in actions of self harm.  This psychiatrist can only recommend people are admitted, but cannot create the NHS beds for them to be accommodated.  These people are also, ultimately, turned away.  They might return, ever more desperate, ever less able to communicate, ever more extreme in the physical actions they take. The chronically underfunded NHS, teetering on the point of collapse, ends up labelling these people “attention seekers”.  And, implicitly, that means ‘not in need of attention’.

Attention seekers, in an age of YouTube and Facebook and make-your-own-celebrity, who instead chose to endanger their lives and permanently alter their bodies rather than start a blog (hey-oh!) or a YouTube channel or an Instagram account? Something doesn’t add up there, does it? If this was about seeking ‘attention’ there are a hundred easier routes to it.  Self harm, suicidal gestures, and disordered eating, and a hundred other self-injurious actions are about seeking attention, but not any kind of attention.  Attention – help – for chronic, overwhelming, unmanageable experiences of fear, pain, anxiety, loss or some other catastrophic emotional state.  They are the last refuge of people who either cannot discover the words to convey their emotional state and their need for support, or who have communicated their desperate need for help and not been heard.

Why else seek attention through actions, unless because nobody is listening?

My conclusion is two-fold.

On a personal note, I remind myself of all of this as I wrangle self-harm impulses.  I don’t want to self harm, what I want right now is help with these unmanageable emotions of stress, anxiety, and fear.

More generally; that attention-seeking is not bad, or wrong, or evidence that there is not a mental health condition, an emotional need underlying it.  That we must care for, and be patient with teenagers in particular and be cautious not to dismiss their actions as dramatic or (most hated of words) ‘angst’.

People ask for help in many ways – often it is not with words because those words are either not available, or not heard.

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Travelling whilst Cyclothymic

I had a disappearing comment on the blog today asking for advice or thoughts on long-term travelling/backpacking whilst cyclothymic™. I think it’s something I can offer some comments on, as I do have some experience.

I try and travel regularly: living in Europe (although I don’t get to be a proper European for much longer *weep*) gives me a huge number of cheap options for getting out there and seeing the world.  My two most recent trips were one trip for 12 days backpacking through 4 cities and 2 countries, and a 3 day trip to one city. 10 years ago, before I was diagnosed, I did a massive backpacking trip around the world for a little over 6 months. It’s this experience I’m mostly drawing on here.

In my 6 months of backpacking, there were exquisite moments, but there were also truly awful times.

I vividly remember sitting on a bed in some anonymous budget hotel in Montevideo. It was early afternoon and I’d been sleeping for about 14 hours. I was looking at the window and, for the first time, I had just the most visceral understanding of why they put locks on hotel windows/don’t let you open them. I sat and I wept. Then the phone rang, I stared at it for ages, trying to imagine who could be phoning me. I eventually decided to answer, in my halting Spanish. It was a friend I’d met a few days earlier and who I was travelling through the country with. She wanted to know if I’d like to go to McDonalds. I agreed, and met her in the hotel lobby 15 minutes later.

McDonalds didn’t cure me, of course, I was depressed for a lot longer than one lonely hour sitting on a bed. But it was a reprieve from myself, and that was all I needed to get through the rest of that day.

I hate Uruguay now – and it has nothing to do with the country or the people – only my truly terrible emotional state while I was there.

That isn’t really advice.  But it is an introduction to the possibilities of travelling.  You’re away from your support networks, you might be disconnected from online support too – although that’s less common now, but when I was travelling 10 years ago Wi-Fi was not really A Thing, and I didn’t take a mobile phone with me. You’re also less accountable – how long could you fall of the face of the planet for before someone noticed, compared to when you are at home?

Here are a few things to consider if you are considering travelling and have cyclothymia:

  1. Travelling is tiring and will disrupt your sleep patterns. For any flight more than 6 hours long, you need to schedule a day off immediately following landing/arriving to dedicate to sleep/sitting around/having a very low energy day.
  2. For long term travel you need to build routines into your stops. Can you get a part time job at a place which you plan to stay at for longer? Do you want to enrol on a language course for an hour or two each morning for a month? Is there a place you can go everywhere to give you a sense of familiarity (personally, and slightly shamefully, I’ve been to either Starbucks or McDonalds in every country I’ve been to – and I’ve been to a lot of countries). When I’m starting to get hypomanic, or depressed, that carbon-copy familiarity can help ground me a bit.
  3. What are your strategies for dealing with dangerously low mood (think me, on a bed, looking longingly at a window, in a shit hotel in Uruguay)? Will you be travelling with a friend or partner; do you have an international calling bundle on your mobile; is there someone who will accept a collect call at any time of day (time zones!) and can talk you down? Have you got travel insurance with an affordable excess, on which you fully disclosed your bipolar/cyclothymia? You’ll need that to access a consultation with a GP/short term medication/review of existing medication if you are already taking it. Similarly, if you are taking psychiatric medication, you’ll probably have to get repeat scripts whilst you travel – so you may need a psychiatrist’s letter, and to confirm your particular medication is available in the countries you are travelling to.
  4. Sleep! Sleep is so important to maintaining my mental health and sleeping in hostel dorms is pretty much the opposite of achieving good, quality sleep [case in point; my experience in Singapore is number 4 on this Buzzfeed list of strange-shit-that-happens-in-hostels]. It can be a good idea to both budget for and schedule time in private rooms or hotels. 2-3 nights uninterrupted sleep, especially if you have an en-suite and a TV so you can just hole up for a few days and reset, is about the best thing you can do to take care of yourself. I did this a few times whilst travelling and it was money well spent every single time. My more recent short-term travel is something I still plan around having one to two days recovery time when I get home.
  5. What are the hardest things for you about being either hypomanic or depressed? For me, it’s the nervous/anxious habits and fixations. I cannot cope with ‘dirt’ – real or imagined. Hygiene standards whilst backpacking can be pretty variable. Your fellow backpackers may have some fairly singular ideas about what constitutes appropriate bathroom etiquette, and don’t even get me started on kitchens. What strategies are you going to have to deal with that? If you don’t have funds to decamp to a mid to high range hotel at the first sign of trouble, you’re going to need to be more creative. I carried a thin blanket, and a few items of cutlery which I resorted to when I stopped trusting the cleanliness of bedding and self-catering facilities (I’m in a low mood period right now, and just thinking about using unfamiliar cutlery is making that dragon of anxiety rear up in my chest). I also, on my long trip, travelled with my-then-partner and she did sometimes take up the job of scoping out the cleanest bathroom or pre-washing cooking material. It helped that she tended toward obsessive cleaning in this respect and appreciated terror at ‘dirty’ things.
  6. Travel can be lonely. Don’t think for a minute that taking a laptop or tablet and staying up to date on social media is going to be a substitute for hanging out all evening with your oldest friend and putting the world to rights. There can also be a real pressure to be seen to be having a good time whilst travelling. I found it really hard to update friends (with whom I would normally discuss my mood) that I was experiencing depression whilst I was travelling. Because who could be unhappy whilst on a picture-perfect Brazilian beach, right? A good old fashioned paper journal where you honestly record how you’re feeling can help ‘get it out’ (I still have mine – it records the highs and the lows from my trip and I’m glad I have the honest account of it, as well as the edited snapshots of me smiling on beaches and in rainforests) You might also try and schedule regular Skype dates with close friends where you give yourself enough time, and privacy, to actually talk properly about your feelings. Finally, you might want to travel with a friend, or arrange to travel with other backpackers you meet for short (or long!) periods.

I can’t stress enough that making the decision to travel is not all about planning against the worst. From a cyclothymia point of view, I think there are a lot of positives to long-term travel.

Travel is good.  Personally, when cyclothymia gets oppressive or I start cycling too fast, a change of immediate surroundings helps ease that sense of crushing weight or inescapable thoughts. Travelling – especially backpacking – is about doing just that; being able to pick up and run.

I also find it really hard to be mad around people – when I’m feeling particularly mentalist and maybe having ‘strange’ reactions where I talk too much, or get distressed by certain noises, smells, or just get caught talking to myself – I’m mortified to have to see the people who witnessed it, again. The advantage of travelling is that when you’ve made a ‘bad’ [read: they’ve all clocked me as a mentalist] impression, you can just move on to your next stop and never see those people again. Problem solved!

Someone said to me, before I travelled, that your worst day travelling is still better than your best day at home.  I don’t know if I’d make quite such an extreme claim, but I do think it’s easier to keep your mood moving on when you are in the midst of a lot more activities, a lot more options, and a lot less rigid routines. Yes, you need to make choices and maybe put in place a few more protections/insurances than your ‘standard’ backpacker, but if you’re doing that in your daily life anyway, it’s not a particularly onerous task and has much bigger rewards.

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