Tag Archives: mental health

The Not So Secret Life of the Manic Depressive

On Monday of this week, 15th February, BBC showed a documentary [still available to watch on iPlayer if you are in the UK]  following up on Stephen Fry’s landmark documentary on living with bipolar disorder, The Secret Life of the Manic Depressive, which was shown 10 years ago.  I remember watching that documentary vividly.  So much of what I heard and saw from the contributors resonated with me – I didn’t have a diagnosis of cyclothymia then, but I did have suspicions.

This blog is part live blog, part reflection on the show. In bold is the key event/moment in the show, the rest of the paragraph is my commentary which I hope will be intelligible even if you have not watched the programme.

Stephen Fry, post suicide attempt, decides to see psychiatrist – and then he sees one!  This is evidence of a BIG difference between private healthcare and dealing with the NHS. And he tells us he was immediately admitted to hospital. Again, wildly different than experience of NHS – with the enormous and unending cuts to NHS mental health services there are no beds. And in most cases there is no possibility of hospitalisation without a section – and a good deal reliable rumours suggest doctors are avoiding sectioning people who need it because they simply have nowhere to place them.  Stephen Fry’s experience is (absurdly given how essential mental health treatment is) one heavily inflected by his economic privilege.

Kids in the school talking about how “bipolar” is used as an insult really drill to the heart of living with bipolar spectrum disorder.  People do not like it.  It’s not charming, it’s not represented as ‘useful’ (however inaccurate that is) and featured in a regular show, it’s not cool.  It’s also something I reflect on a lot in terms of disclosing my mental health issues – I am always conscious that once people know my diagnosis they will rationalise or dismiss everything I do or say in reference to that label – enthusiastic? Nope, just bipolar.  Annoyed? Nope, bipolar. Inspired? Loud? Introverted? All symptoms.  You stop being a person.

Stephen Fry’s psychiatrist is talking about how difficult travel and crossing time zones can be to managing your mood. It reminds me of the difficulties I had whilst I backpacking round the world with my then-partner.  She would become furious that I was exhausted by our flights across time zones, and furious my mood would plummet with my exhaustion, and furious I could not explain why I was so unhappy so suddenly.  It made me anxious, guilty, furious at myself.  I turned her lack of understanding inwards and began to hate myself for all the things I wasn’t; all the ways I couldn’t be.  We split up many years ago now, and since then I have learnt a great deal about my needs in terms of rest and sleep – but those experiences burned me and I find it difficult to imagine being in a relationship ever again.  Who would live with cyclothymia if they didn’t have to? That’s what dating someone with cyclothymia means; you have it, we have it.

Narrator is talking about frequency of self-medication versus reluctance to take prescribed pills.  Sadly, the show seems to dismiss this as bipolar folk simply being unwilling to put up with side effects and preferring to manage our conditions in other ways.  This obviously resonates with me – I’ve written before about self-medicating and my attempts to manage my cyclothymia with lifestyle and other changes.  But, as I’ve also written, the choice between medication side effects and uncontrolled mood swings is nowhere near as simple as psychiatrists would have you believe, or this program suggests.  Medication side effects are brutal.  Not enough is done to facilitate good medication choices, not enough is done to help people manage the side effects, not enough is done to acknowledge how destructive side effects can be on every other part of your life.

I note that, in reference to Scott’s experience, the psychiatrist shrugs off his query/anxiety that he will be ‘like a zombie’ on mood stabilisers, exactly the conversation I had with a psychiatrist, and it proved completely inaccurate.  I was zombified.  It became untenable for me to live like that.  No follow-up on Scott after he doubles his lithium dose, I hope it works for him, I fear it won’t.  I note also, there’s no discussion of talking therapies or alternative approaches to treatment – it’s ‘medication or nothing’ on the NHS, regardless of how ill fitting that may be for an individual.  This issue – and the considerable weight of evidence which suggests medication-as-only-intervention is an inadequate way to manage mental ill health – is offered in response to the show in this blog by Richard Bentall, Professor of Clinical Psychology at Liverpool University.

Rachel’s story of experiencing her worst lows at night, alone, as a teenager resonates with me.  The difficulty for parents to identify more-than-average-teenage-melancholia is enormous. The story of medical services failing to identify her mania after she jumped from a balcony is all too common.  The discussion between Rachel and her CPN about sectioning her if she becomes a danger to herself in future is really concerning for me, because it’s evidence of fire-fighting rather than working on managing and improving her overall health through a variety of interventions (not just medication, which is all they say she has currently) now.  But I may be making too many assumptions with not enough information here.

It strikes me there is an enormous selection bias in this show towards people who believe it is easier now than ever to speak about mental health issues and receive a positive response.  Because if you’ve not disclosed to your friends, wider family, whatever, it’s because you are aware (or sure) of the potential for a negative reaction – so you’re certainly not going to blow your cover by contributing to this show.  If you’ve experienced negative responses you are not going to keep talking – this idea that ‘we’ can only combat stigma by talking is incredibly problematic for me.

When you are subsumed under stigma, you simply cannot speak, cannot contribute to some ill defined, under funded campaign to combat stigma.  Time to Talk Day came and went this year and I did not mark it on here.  Why? Because I didn’t talk about my mental health on that day to anyone who did not already know.  Had any of my friends who do not know about my cyclothymia asked how I was, I would not have disclosed my difficulties to them – not least of all because my mood was pretty good on the 4th of February, but also because a charity-sponsored day does not make people more prepared to deal with the mental vomit that is chronic mental ill health and the ongoing needs and demands that generates for me.

On Time to Talk Day  I asked all my friends how they were and made myself available to them in all the ways I always do.  But whilst starting a conversation may be a manageable goal, it’s continuing conversations about mental health that is the hard thing, and it’s continuing conversations which will actually start to change or erode stigma, and generate sufficient public feeling to pressure the government to actually invest in mental health services.

The ‘not so secret life of the manic depressive’? For me, save for this blog, it’s still a secret. Stigma around mental ill health is still enormous. And there is still so little out there to help people like me – and people, perhaps, like you – live with bipolar spectrum disorders including cyclothymia; regardless of well intentioned attempts of shows like this to change that.

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World Mental Health Day

I planned to post yesterday in recognition (celebration doesn’t quite fit does it?) of World Mental Health Day but my home broadband is on the blink.  Although, posting a day ‘late’ sort of illustrates what I want to talk about today.

I’ve always been a bit sceptical about specific ‘days’ for various causes, awareness raising or similar because what does it mean to say there is only one day you need to stand against homophobia? Or only one day on which bisexuals become visible? Or only one day on which we need to try and prevent suicide?

I like the idea of rallying people to a single day, bringing the energy together all at once for one big bang of impact.  I understand none of us have the energy to fight, full whack, every day, for each and every cause that has a day. But how many people think about these causes on other days? How many people thought about the importance of campaigning for better funding for NHS mental health services today? How many will think about it tomorrow? How many will act on it next week? Next month?

I don’t have much confidence in ‘awareness’ days. I don’t think they shift how people think of things in any significant way. And I think it’s too easy for politicians, celebrities, and anyone else with only a passing or superficial interest in these topics to ignore the ongoing issues of underfunded mental health services, and WCA-driven suicides (to mention just two of a hundred pressing issues) if they have paid lip-service to ‘caring’ and being ‘active’ on those things in the news and papers the day before.

Ultimately too, for me and for so many of you reading this, ‘mental health day’ is every day of our lives. Thinking about how my mental health is today (good, bad, hypomanic, depressed, stable, wobbly, neutral…) is the most consistent, basic way in which having a mental health problem has reshaped my life.  Even when my mood is fine – neutral, not at either end of a swing – contemplation of my mental health is the foundation of my day. How do I feel this morning? How much can I do? When will this stable mood end? How much can I do before then? What should I commit to now if I might be miserable next week. For this reason, days like World Mental Health Day seem like another reminder of my difference from the cognitively normal who get to neatly end their contemplation of mental health with the conclusion of the day.

What do you think? Does World Mental Health Day mean something significant for you? Does it achieve more than my cynical rendering acknowledges?

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Thinking about chronic mental ill health

I’ve been reflecting recently on the way I view my own mental health.  I write often on here, and on twitter, about hitting a ‘hypomanic period’ or a ‘depressive period’ because, as I leap from one to another, I think of them as separate events.  But not only does a hypomanic ‘period’ inevitably lead into a depressive one, they aren’t isolated incidents.  They are, cumulatively, cyclothymia itself.

It’s been useful (necessary?) for me, up to now, to think of them as separate events which I pass between and through rather than thinking of them, along with my ‘stable’ periods, as a whole, and a connected manifestation of cyclothymia.  I needed to think of them as distinct periods which had clear starts and ends because then I am not always ‘within’ cyclothymia – I didn’t know how else to conceptualise it, how else to describe it without suggesting it defined my entire life.  Increasingly, this kind of thinking has made me feel more despairing about experiencing highs and lows; why can I never stamp those emotions down permanently? Why do those feelings keep resurfacing when I beat them down last time? What am I doing wrong that I can’t win the war?

I’m thinking, today, about the language of chronic illness.  I found this article an interesting read: 5 ways you’re not ‘living’ with chronic illness which recommends some shifts in how we think about our own chronic ill health in order to prevent it taking over/directing one’s entire life.  When I decided to stop therapy and come off meds I believe I addressed the first point – stop looking for the why.  There are many, many theories from genetic to social and beyond that propose reasons why individuals develop cyclothymia and other conditions; none of them offer me a solution. So why was I pursuing treatments which offered me little help but were founded on one or more of those theories?  As I’ve said before, med free is not the right choice for everyone, but I got so little from the various drug treatments I tried, walking away instead of pouring more energy into finding the ‘miracle’ cure for me was the right way to stop living under cyclothymia and start living with it.

Point 2 is also something I’m fortunate I’ve been able to achieve.  

Point 3 gives me pause though; you’re not living with chronic illness if you’re hating yourself.  Self-loathing is both symptomatic of cyclothymia and caused by it.  I, like many other people I have spoken to with this illness, have lost things and people that mattered because of some of the ways cyclothymia manifests itself in both action and personality.  And, as I mention above, I come to hate myself for not being able to fix myself, for not being able to simply step out of this restrictive jacket of cyclothymia and into a life of cheerful ease.  Which leads me, as it does the article, into point 4; you’re not living with chronic illness if you’re fighting it.  This doesn’t mean stop trying to improve my health and manage my illness; it means accepting a paradigm shift from thinking of it as something to be ‘cured‘ or ‘fixed’ to thinking of it as something to be managed, contained and yes, as the article’s title says, lived with.

I am not failing because the ups and downs keep coming. I am not [and I struggle to write this, but I must try to explore the idea] unlovable because I have mood swings.  I am coping.  I am managing to get through my life in lots of ways that are great, and celebratory.  I am not a fighter – I am resilient.  Winning (if we must persist with the language of a fight) with chronic illness like cyclothymia, means carrying on each day and finding and using new ways to make life easier, moods more manageable, and life more fulfilled.

For example, right now I’m once again in a particularly brutal down-swing.  And I find myself compulsively harming myself; simply to contain my emotional extremes, in order to, for example, prevent myself from crying on the bus home, or from weeping during a party.  If I think of each down-swing as a separate event, I have no explanation for my self injurious behaviour.  

If I think of all my down-swings as part of a single experience of mental ill health (which of course, is precisely what it is and why my entire emotional experience is diagnosed with a single condition) then my current behaviour is simply a resurgence of a symptom I have less frequently than some others. It’s just a ‘flare up’ of one of the least pleasant elements of this illness. And if that’s true, it’s not that I’ve totally failed to maintain my previous progress, it’s just that, this time, the down-swing is particularly intense and as long as I keep moving forward (point 5 from the article) after this, and keep thinking of what I can do to make those symptoms less destructive and emerge less frequently (perhaps by identifying what has pushed me that bit further this time – stress?) then I am living with cyclothymia. I am still in control.

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Creativity and Mood Swings

I have a real problem with the persistence of the idea that madness – in any of it forms but most often bipolar spectrum conditions – gifts sufferers with unique creative abilities.  This idea is circulated by seemingly unending articles and books featuring the work of artists who ‘suffered’ from Van Gogh to Sylvia Plath, Amy Winehouse to Virginia Woolf.

In part, I (and I’m not alone in this) think it’s a case of uneven representation – the many bipolar and cyclothymia sufferers who produce nothing of artistic or literary value are never reported on, the tiny fraction who do are proportionally over represented.  There are some convincing studies which suggest creative professions are disproportionately populated by people with mental health problems – again I feel cause and effect are getting muddled here.  Madness does not make you creative but if you are mad, creative industries are one of the few which are flexible enough to allow mad people (whose ability to work varies wildly as their health fluctuates) to succeed.  It’s something I wrote about briefly in the Great Big Cyclothymia Q&A in relation to work.

I can almost hear someone out there asking ‘why does it matter that people say creativity and madness go hand in hand? It’s only ever a compliment!’.  Well, quite simple; with the suggestion that madness gifts creativity and originality comes the implication that in the misery of mental ill health we should be celebrating our unique, special and oh-so-valuable gift of creativity.

I’ve often tried to comfort myself with that pleasant lie; ‘I’ve got as far as I have because cyclothymia has given me this bolts of insight’ – both when I am hypomanic and when I am depressed.  But the truth of it – or at least the thing that feels more true – is that I’ve got as far as I have with my academic studies in spite of my poor mental health and not because of it.

Despite this – or perhaps because of my own uncertainty about whether I am helped or hindered by mood fluctuations – I find depictions of madness in art and literature absolutely fascinating.  I recently read Barbara Stok’s Vincent which manages to beautifully illustrate Vincent Van Gogh’s period living in the South of France.  I was particularly struck by the way she illustrated Vincent’s deteriorating mental state.  In the three panels below, taken from several pages apart, you can see the ‘specks’ closing in on Vincent (click to embiggen).  The clear skies of the first panel become busy as Vincent begins to panic in the second, and finally almost obscure the colours around him as he becomes despairing in the third panel

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Later still, in moments of agony and disassociation, the frames spill out from their previously precise squares into jagged explosions.  What a remarkable skill Stok demonstrates, to so ably transfer a mental experience to a visual one.  And that, I realised as I read Stok’s book, is what really appeals to me in depictions and descriptions of mental ill health.

From Allie Brosh’s now famous depiction of how depression feels and Ruby Etc’s comical piece on how listening to music can vary so wildly with bipolar, to monsters which illustrate different mental health diagnoses and the exploration of anorexia Manic Street Preachers offer; art can tell us something helpful about mental ill health.  It can, in a way more immediate than dense prose or long blog posts (!), assure us our experiences are shared and give shape and substance to that thing inside ourselves which we struggle against.  Perhaps that’s also why so many people with mental health struggles feel compelled to try and record something of them in their creative output; naming the beast, drawing the beast, finding the beast in the hope it can be slain.

As for creating art and literature when mad? It has before now been a way I monitor my own mood* and what I produce when hypomanic versus when I am unhappy, or even fairly stable, is one of the many signals I use to understand when I need to take a break, ask for help, or even schedule extra working time into my month.  But does any of it happen because I’m mad? No, it’s always the things I would be doing anyway amplified, or muffled.

 

 

* I produced two self portraits some years ago, the first when I felt fairly stable, was in my typical style, the second when I was hypomanic came out of me without my really understanding how I painted so differently.

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The Great Big Cyclothymia Q&A

This Q&A is almost entirely composed of search terms which have brought people to my blog.  I’m no expert, but over the years I like to think I’ve collected some instructive experiences and learnt, often from my mistakes, a few things which may, if not help others, then at least provide them with a perspective to consider as they continue researching these things.

How do you deal with a colleague who has cyclothymia?

I recommend dealing with a colleague who has cyclothymia in exactly the same way you deal with a colleague with curly hair.

If you would like to help a colleague who has cyclothymia then your first stop should be having a conversation with them about what they might need in the work place – it could be a friendly face, a regular coffee break or lunch-date with a colleague, it could be additional meetings with line managers to help flag up feelings of being overwhelmed or excessively stressed before they turn into massive problems.

If you have cyclothymia and you’re thinking about how to deal with this at work I recommend looking at the Mind website. They have extensive advice on being mentally healthy at work and the possible risks and benefits of ‘coming out’ at work about your mental health issues.  I personally have never disclosed a mental health problem to an employer, with mixed results.  The most negative experience was when I was a manager and my staff told me “you’re funny because you’re great to be around sometimes because you’re so enthusiastic and positive but sometimes you’re incredibly grumpy and it’s no fun working here then” which came as something of a surprise as I thought I was hiding my mood swings well.  If you’re considering disclosing your mental health status to an employer or colleagues remember that they probably already know something about you is cognitively….off.

Can you hold a job with cyclothymia?

This really isn’t a question with a definitive answer.  It depends on you, how well you are able to manage your moods, how you respond to stress, how much stress your job entails….Personally. I’ve found jobs which have a degree of flexibility – for example office work which has varied tasks to be completed in a month ranging from mindless data entry to complex accountancy work – to be one of the better positions I’ve held as I was able to set my own schedule for the day or week, and work around my capacity for concentration and originality at any given time.  Conversely, working in customer service, whilst tremendously easy when hypomanic, was excruciating and often-times disastrous when I was depressed.

Holding a job with cyclothymia, like any other mental health issue, is a question of how well you manage your symptoms, what degree of flexibility you need and can have, and how much you disclose to an employer and their response.

Is cyclothymia an excuse/reason for being rude?

It’s not an excuse, but it can often be a reason.

Both highs and lows bring their challenges for social interaction.  I talk over people when hypomanic and am curt with people when I am depressed.  I work hard to remind myself to think first and act and speak second.  But impulse control, as you likely know if you are reading this, can be a huge challenge when at the extremes of mood.

I always maintain that no matter what my mood, I am accountable for my actions – I apologise to friends and family I think I may have offended or upset as soon as I am able, and I try and let close friends know where my mood is so they can be prepared for some irrationality.  How well your friends tolerate your moods is down to a lot of factors – their patience and understanding, your willingness to be accountable for your actions, and sometimes, just dumb luck.

Should I tell my friends I have cyclothymia?

My close friends know, acquaintances and colleagues don’t.  As I say in the above point, having your friends understand why you may act erratically or very differently from one week to the next can help you maintain better relationships. Friends can also offer support and understanding when you really need it.

In the end, it’s up to you – what do you want to get out telling your friends? Do you want to help them understand you better? Do you want to ask them for support in some areas of your life? Do you want them to know that you understand their struggles with mental health because you have your own? All good reasons to share. If you want to tell your friends in order to get a carte blanche to treat them differently or to demand they alter their behaviour around you then you may want to think more deeply about how you relate to these people and what is reasonable, or unreasonable, to ask of people.

Does cyclothymia affect concentration?

Poor concentration is a symptom of depression.  Inability to focus on a task or subject for an extended amount of time is a symptom of mania and hypomania. So in summary? Yes.

Anecdotally, my concentration levels are one of the key ways I monitor my moods.  The moment my concentration drops significantly, I know I’m heading up or down.  We’re talking about something more significant than a tendency to procrastination, or that fidgety Friday feeling we all get; we’re talking staring at a page and reading the same sentence 6 times but taking nothing in. We’re talking abandoning one task to begin another because a better idea just occurred to you.  Lack of concentration, when it’s symptomatic of cyclothymia, describes just not being able to discipline or motivate yourself into acting in any other way than you are; it can mean doing a job is like wading through treacle so hard it is to make your mind process anything, or feeling like a butterfly on speed, flitting from one idea or job to the next without a pause in between, but completing nothing.

What are the habits or behaviours typical to cyclothymia?

I’ve written in various entries about some of the common experiences of cyclothymia, from hypomania, to anxious compulsions, to the suddenness of the onset of mood swings which is characteristic of cyclothymia.  I tag entries dealing with my experiences of specific symptoms of cyclothymia with ‘symptoms and habits’

To a degree, manifestations of cyclothymia are as unique as the sufferers, in other ways, there are a distinct list of symptoms which we all experience to a greater or lesser degree – some of which are also common to other mental health disorders.

Is my psychiatrist right about cyclothymia?

Short answer; yes.  Long answer; no.

Psychiatrists have a habit of telling people with cyclothymia that without treatment it will develop into bipolar II but this seems to be anecdotal and difficult to disentangle from people being re-diagnosed with Bipolar II after not responding to treatment for cyclothymia.  Psychiatrists, in my experience, also have a habit of insisting your life will be dramatically altered because of cyclothymia, and that you cannot successfully manage it alone – this may not be true, or it may.  There are so may variables in anybody’s life which make such pronouncements utterly meaningless.

Seek advice and information on cyclothymia from your GP, psychiatrist, from Mental Health charities or advisers, and speak to other sufferers.  Do not allow yourself to be pressured into decisions or treatments you feel uncomfortable with and feel empowered to ask for second opinions.  Psychiatrists do not have all the answers, they are not sooth sayers, they do not have a crystal ball.

I wrote a little on my experiences of following, and not following, a psychiatrists advice in my post ‘things I want you to know if you have cyclothymia

Can you manage cyclothymia without medication?

Perhaps.  I can.  Or rather I am trying.  Its a continual process and it depends heavily on your lifestyle, your job, your experiences of medication and your ability to maintain healthy routines.

I have written here, and here, about my attempts to manage cyclothymia without medication.  After a few years, it’s still currently the right choice for me; it may not always be the right choice for me and it may never be the right choice for you, but it is possible.

What medication can be used to manage cyclothymia?

I have taken a slew of anti-depressants and the last medications I was on were Seroquel and Mirtazipine which worked to an extent but ultimately I decided the benefits were outweighed by the side effects.

Wikipedia has a very brief list of the medications commonly used to treat cyclothymia as does the NHS choices website (scroll down for ‘How is it treated?’) For detailed information on a drug you have been prescribed I recommend asking your doctor or psychiatrist, and having a look on the Crazy Meds site which I have always found to be both frank and accurate.

How do you live with cyclothymia?

This is the question my entire blog is aimed at exploring.  There isn’t, I am confident, a single answer.  I’m finding careful use of some medications (anti anxiety and sleeping tablets), occasional short courses of talking therapy, healthy physical routines and habits, and being tolerant of my own fluctuating reserves of energy and resolve, all contribute to me feeling in control of my life with cyclothymia.

It’s not an easy road, but it is one that it is possible to walk, with time, and effort put into finding what does and doesn’t work for you – either alone or in conjunction with mental health professionals, and supportive friends and family.

And finally, a google search term I couldn’t turn into a question;

Cyclothymia and stupid people

Unfortunately, cyclothymia does not bestow you with the super power to avoid stupid people, or eradicate them from your life. Sorry.

Have you still got a question that needs answering? Do you want to add to or query any of these answers? Please drop me a line in the comments.

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Head above water

I’ve been struggling to turn any of the drafts sitting in my WordPress dash into posts in the last few weeks.  I’m super low on energy just now and have spent the last week and a bit shunning most day-to-day social interactions and doing what I can to conserve the energy I have.  I know that this is a herald of a down-swing, how severe that down-swing is depends – I’ve found over the last few years – on how rested I am.  Until it reveals itself I’m living, fairly happily, as a hermit.

Today I went swimming, it’s one of the few things I do no matter where my mood is, and universally makes me feel better.  When my head is under the water and my whole body is working to propel me forward, my mind goes quiet.  I was struggling today and felt as though I was a car revving in neutral – no matter how hard I pushed I just couldn’t seem to generate my usual speed and ease in the pool. I think perhaps I’m carrying a virus and it’s wiped out my (physical) energy reserves.  I felt heavy, almost as though I couldn’t float.  Which reminded me of an opinion I held as a child.

I could never understood how people who could not swim, drowned.  For me, floating is second nature; I can’t remember a time I couldn’t float. I relax my muscles, let go, and I float the surface of the pool.  I recall asking my mother why non-swimmers didn’t simply relax and wait to float.  Of course, drowning – and floating – are rather more complex than that, but it did get me thinking about the commonly used metaphor of struggling with mental health issues as being like drowning.

Right now I’m rationing out my social life, pushing myself to meet up with friends at least once a week even though all I want to do is stay home and listen to music.  It’s a bit like trying to take big lungfuls of air when sinking below the waterline is an inevitability.   I recognise these last gasps of air will sustain me when I simply cannot socialise, but taking them hurts; my lungs are already beginning to burn, my muscles ache, I want to let go and let my head dip below the water’s surface.

As you drop below the surface of a pool, sounds become muffled, the water presses in around you, your body is suspended – neither floating nor drowning.  Just hanging between the surface and the bottom.

Cyclothymia can be like that.

Part of the world and yet separate.  Seeing the same landscape as everyone around you but through a lens which distorts and refracts.  Hanging between sane and crazy, floating and drowning.  Half-welcoming the silence and calm that comes as you dip below the surface, half fearing it because after a few moments – or days – luxuriating in that silence your lungs begin to burn and feel like they will burst, the surface feels too far away to reach before you let go of your breath and suck down a lungful of water…

But I’m not drowning quite yet.  At the moment I’m floating on the surface, sculling along with my ears below the waterline, only conscious of the water lapping against my cheeks, sounds coming to me distant and echoing…calm, quiet, alone.

 

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