Those whom the Gods would destroy, the old saying goes, they first make mad. But it wasn’t the Gods who drove me to madness and destruction. It was me, writes Horatio Clare
Those whom the Gods would destroy, the old saying goes, they first make mad. But it wasn’t the Gods who drove me to madness and destruction. It was me.
Two years ago, at the age of 45, I had a catastrophic breakdown. I believed I was in contact with aliens.
I was going to marry Kylie Minogue. I rolled my car down a hill and ended up naked on the roof of someone else’s. I was sectioned and detained in a mental hospital.
Although a psychotic breakdown is lonely and sometimes scary (and absolutely terrifying for friends and family — especially for my partner, Rebecca, and the children, though she tried to shield them from it), I did not find the experience truly frightening until I was sane again, and facing a psychiatrist in the mental hospital.
The causes of my breakdown were no mystery. I had been up and down before, tending to high, sometimes manic, feelings in the summer and low, depressed ones in the winter. It didn’t happen every year but I had highs every three years and lows every two, roughly.
Neither was particularly dangerous and I had not been treated for them. For the winter lows, doctors had suggested antidepressants, which I have always rejected, and vitamin D and omega-3 supplements, which I still take.
But this time, combined with a ferocious workload, a home life under pressure, a tendency to push myself too hard and the secret abuse of cannabis and strong drink, which I used like rocket fuel to drive me on, I fell into the grip of a manic high. It ballooned into raving madness.
Fortunately, it took only a couple of doses of powerful anti-psychotic medication, and the sobering experience of being in a well-run hospital, to drain the delusions out of me. The staff said I ‘presented as sane’ after a couple of days.
You might imagine that being sectioned in the locked ward of a mental hospital, and finding yourself negotiating with a psychiatrist who has the power to keep you there indefinitely, would be a rare experience.
In fact, it happens to about 60,000 people in Britain every year, and the number is rising. That is the population of a city the size of Inverness.
If you are admitted under Section Two of the Mental Health Act, as I was, you can be held for up to 28 days, when you must either be released or put on Section Three, when you can be held for up to six months — and it is renewable.
Although you can appeal, in practice the person who controls the lives of all sectioned patients is your responsible clinician, who is a psychiatrist.
You might imagine that being sectioned in the locked ward of a mental hospital, and finding yourself negotiating with a psychiatrist who has the power to keep you there indefinitely, would be a rare experience. In fact, it happens to about 60,000 people in Britain every year, and the number is rising
You are meant to meet your responsible clinician within 72 hours of being admitted: that didn’t happen, but in a few days my appointment came up and I faced the man who had more power over me than anyone in my adult life had ever had, or is ever likely to again (fingers crossed).
In the drab environment of our locked ward, Dr X was strikingly smart, in a beautiful tweed suit, linen shirt and expensive shoes. His power was lightly worn. He spoke softly and looked at me carefully as he introduced himself.
‘How are you feeling today?’ he asked. I told him. My belief, which never shifted, was that I had broken down for clear, explicable reasons, and that by changing my behaviour and adjusting my lifestyle, I could avoid it happening again. Dr X disagreed.
‘What has happened to you, and your history,’ he said, ‘gives a clear presentation of bipolar disorder. You will need long-term medication.’
I didn’t know much about long-term medication, then, but I was wary. The thought of side-effects and a lifetime of pills made me fearful and suspicious.
I was only just beginning to recover, shakily, from a breakdown, hardly daring to face the damage and pain I had caused my family and friends. I was mistrustful of everything, including my own judgment.
Before our second meeting, I wrote pages of notes. But even as I scribbled down reasons why I should be released, I knew it was hopeless. When you are sectioned, you soon realise the surest way to stay locked up is to claim you are sane.
Disagreeing with your diagnosis or objecting to your treatment is taken to mean you ‘lack insight’, that you are not capable of rational judgment, that you ‘lack capacity’ to understand what is best for you.
If you refuse to take medication you are ‘non-compliant’, which is further evidence for continuing your detention. And you can be compelled to take medication — a horribly traumatic experience for the patient and the staff who administer it, as the patient is pinned down and injected.
I liked and admired Dr X and the nurses, ward managers and support workers who cared for me and my fellow patients. They were caring and always professional. No doubt they had a great deal of experience of people who really did lack insight and capacity, who protested that they were fine.
We patients knew what was required. We said we felt fine but made it clear that we understood we had been ill, were still ill, and wanted to co-operate in our treatment.
There was never any suggestion that something had happened to us from which we might one day walk away. The feeling was that we were there because there was something fundamentally wrong with us, somewhere in our brains. And no one was going to get out without a prescription for years, perhaps a whole life, of pills.
I was only just beginning to recover, shakily, from a breakdown, hardly daring to face the damage and pain I had caused my family and friends. I was mistrustful of everything, including my own judgment [File photo]
The most frightening moment came in that second meeting, after Dr X had made it clear that my only way out would mean agreeing to long-term medication. ‘Yes,’ I said, ‘All right, I’ll take it.’
He passed me three sheets of paper. The first was headed sodium valproate, the second aripiprazole, and the third was lithium.
‘Take these away, read them and choose one,’ he said. I felt bewildered. How was this in any way scientific? In what way was I qualified to make this judgment? Why was the decision down to me, a patient in a mental hospital, and not in the hands of the trained, experienced and highly paid psychiatrist?
The information was laid out clearly but the frightening thing was that the sheets were summaries, designed to make these complicated drugs seem simple and unthreatening.
How they actually worked was not explained — in fact, as I found out later, we don’t know how much psychotropic (mood-altering) medication works. Lithium, for example, was first used as a cure for gout. We still don’t know how it affects the brain.
The side-effects, which were briefly summarised, looked terrifying, certainly to a coward like me. I chose aripiprazole because from what I could tell it started working quickly and was the easiest to come off.
Although it had the fewest possible side-effects, there are more than 20, including trembling, twitching (both symptoms of brain damage), early death (very rare), dizziness, lightheadedness, drowsiness, nausea, vomiting, tiredness, excess saliva/drooling, blurred vision, weight gain, constipation, headache, trouble sleeping and, in certain cases, excess spending and sexual disinhibition.
The last two are also aspects of mania, which I had experienced during my breakdown and never wanted to have again.
Still, I wanted more than anything to get out, so I began taking the pills. Unlike most patients, I had documented my previous history of becoming manic. I had written proof that I had never had an episode without smoking cannabis first.
‘Supposing it’s not bipolar. Supposing it’s an underlying condition which is triggered by cannabis?’ I asked Dr X.
He shrugged. ‘It’s your life,’ he said. ‘You can always stop taking the medication.’ Then he made it clear that if I had another breakdown, I would not be detained under Section Two of the Mental Health Act. Because I would be judged ‘non-compliant’, it would be Section Three. I agreed to take the medication.
After three weeks, having been allowed to go out into town and on short trips home, to prove I could cope with the outside world, I was released from hospital. I began to research what had happened to me and what I might do about it.
I was very fortunate to be commissioned to write a book about the whole story — Heavy Light — which gave me time and money with which to investigate.
It soon became clear that Dr X could not be blamed for his decisions. Another consultant psychiatrist whom I interviewed, Dr Peter MacRae, who works in East London, told me: ‘We don’t know how the medications work. We prescribe by trial and error, by side-effect. But I’ve seen them working. I’ve seen all these drugs working.’
Looking at it this way, Dr X and clinicians like him are being honest. If they had the perfect pill, they would prescribe it. And they feel responsible for their patients. If Dr X had let me go without prescribing medication, and if I had become ill and hurt myself or someone else, he would have found himself answering to a coroner’s court.
Another specialist, Dr Caroline Taylor, mental health lead for Calderdale in Yorkshire, explained that many patients are taking pills to assuage their doctor’s anxiety about what might happen if they don’t. ‘Because I have more experience and I’m confident in the area,’ she said, ‘I’m helping them de-prescribe.’ She is designing a flow-chart to help GPs take people off unnecessary medication safely.
I have nothing but the highest respect for the millions of people who take psychiatric drugs. They are trying, bravely, to help themselves and those closest to them. Many, for the sake of their partners and families, endure powerful and often awful side-effects. They deserve praise and admiration. In all the research for my book, nothing I found made me anti-medication, or anti-psychiatry.
I am not arguing that people should not take psychiatric medication. But I do strongly believe that people should take the absolute minimum, which would be a fraction of what we as a society take now. Instead, we should all be offered options. Alternatives do exist, and they do work. But at the moment, shamefully, you have to be able to afford to pay for them.
Soon after leaving hospital I binned my aripiprazole, which made me feel fuzzy, disconnected and rather out of it.
Three discoveries drove my decision. The first was that drugs address symptoms, not causes. With a private psychotherapist I began a course of trauma therapy called eye movement desensitisation and reprocessing (EMDR). We addressed the roots of my perfectionism and risk-taking behaviours, the childhood experiences underlying the decisions that ended up making me mad and ill.
EMDR works by distracting the conscious brain. With your gaze, you follow the therapist’s finger from side to side and up and down while thinking about a traumatic memory. In this way you come at painful episodes from new angles, digging up buried pain and guilt, which you then discuss with the therapist. I found it tremendously freeing and helpful.
Over two years since I came out of hospital, I have gone mildly high and low without being any kind of danger to anyone: with a healthy lifestyle, good relationships and no cannabis (at last), I am just one of those people who goes up and down with the seasons.
The second discovery was alarming. Despite all our scientific and medical advances, and the massive and increasing number of us taking medication, it is not clear that rates of recovery from breakdown are any better than they were a century ago.
Critics of our current system — and they include many psychologists, therapists and psychiatrists — argue that the mass prescription of drugs may help people function, but they do not cure.
Among the hundreds of messages I have had from readers of Heavy Light are many from people or the families of people who feel that psychiatric drugs have made their lives worse: a whirl of side-effects, and prescriptions to counter side-effects, and no improvement in the ability of sufferers to function or live fulfilled lives. As a society, as a world, we need and deserve better and more effective treatment.
The third discovery came when I interviewed Yasmin Ishaq, a leading practitioner of a treatment called open dialogue. This was developed in the 1980s in Finland, where psychosis and schizophrenia rates were among the worst in Europe.
Open dialogue works by talking: the sufferer, members of their family or friendship group, therapists and a clinician talk together about the delusions, voices or crises the sufferer is experiencing. It has stunning success rates and uses only very minimal medication, mostly at the stage of acute crisis. As I found, taking a pill then, when you are in the grip of madness, is fantastically effective.
But when I asked Yasmin Ishaq, who now leads open dialogue programmes in London, how she would have dealt with me when I was insane, she said: ‘I would have normalised it. I would have said: “This is a completely understandable reaction to what has happened to you, to the stress you have been under”.’
She went on to explain that open dialogue understands delusions as a kind of language, an alternative to a real world that the sufferer can no longer bear.
For people suffering psychosis or schizophrenia, open dialogue reports rates of return to work or study, after five years, as high as 81 per cent, a long way away from the UK average of 5 to 15 per cent.
But the third discovery, the real breakthrough, came in the course of our conversation when she told me: ‘It’s not about curing, it’s about healing.’
If you are diagnosed with bipolar, one of the most frightening discoveries is that psychiatry does not regard it as curable, though it accepts the possibility of remission. Like many others, I agonised over the idea that I must either take life-changing pills, or suffer a disorder that would probably get worse. So this idea — that I did not need to think about cure, but rather a lifelong process of healing — struck me like a revelation.
Being diagnosed as bipolar can be a source of reassurance to some, because it leads to treatment and management of the condition. But for me it was worse than useless. I do not identify as bipolar, but rather as someone who had a breakdown and is healing.
Writing Heavy Light, and the reaction to it, has convinced me we need to think about mental health in a completely new way. Seeing it as a set of conditions that require powerful and scientifically mysterious drugs has only brought us so far.
Instead, I believe we need to see each sufferer’s affliction, from anxiety to depression to psychosis, as a unique crisis that applies only to them. We need to treat each person in individual ways that suit them.
Meddling in brain chemistry is not enough. We need to offer everyone a blend of limited medication, where necessary, and effective therapy, in every case, to address the causes of distress. Every single person in trouble deserves the chance and the tools to heal.
Heavy Light: A Journey Through Madness, Mania And Healing, is published by Chatto & Windus, £16.99.