Mental Illness on Screen: Homeland, Bipolar and ECT

Watching C4 drama Homeland over the last few weeks I’ve been intrigued by – as well as the teeniness of Damian Lewis’s mouth – the portrayal of bipolar disorder which began as an incidental aspect of lead character Carrie’s (Claire Danes) life, later becoming a major plot changer.

wow, that really *is* a tiny mouth

It’s rare to see mental disorders, especially bipolar, represented in a serious manner by TV. Usually we’re a bit of a joke, seen as losers and undesirables, the ones shouting ‘gerbils!’ at the side of a road. So it was refreshing to see Carrie, in early episodes, portrayed as somebody with strengths as well as weaknesses, managing a successful career as well as a personality disorder.

The realism of Carrie’s need to cover up her condition in order to maintain that career especially rang true, and while I’m certainly not a high flying CIA spy or working in any industry requiring one not to be a card carrying nutcase, I have often debated whether or not to confess all (perhaps not all) on an application form and have met people who keep their condition a secret from employers. It’s an interesting debate – should those with mental illnesses be exempt from certain jobs? – though sadly not one that was explored during the course of the series.

During the latter episodes of Homeland, as Carrie’s ascent towards mania continued I felt that the sensitivity was lost somehow. While Danes’s performance was impressive it felt at times that she’d been directed with ‘you’re mad, really mad! MORE crazy eyes!’ to fit in with a script plucked from Wikipedia’s ‘Bipolar’ page.

While I wouldn’t for a moment deny that the symptoms of Carrie’s bipolar – promiscuity, obsessiveness, an inability to look after oneself, risk taking – were true to bipolar life, they were lazy choices that barely scratch the surface of the complexity of the condition. It certainly appeared that Homeland’s scriptwriters had little experience of bipolar and had they took the time to explore further they may have created a more nuanced character and one who was infinitely more likable. It says a lot that for the most part the obsequious wannabe terrorist was a more sympathetic character than the mentally ill woman he was conning.

Even less believable was Carrie’s final scene. I mean, ECT, seriously? I understand that the series is set in the US and doubtless mental health care works differently there, but I find it hard to believe that somebody would walk off the street to be administered a serious, highly controversial treatment that here in the UK is an absolute last resort. Carrie appeared to have requested the ECT but in reality would somebody in a high state of mania have been considered fit to choose? And would her sister, also a health care professional, have allowed her to jump directly from medication to fizzing the fuck out of her brain? Hadn’t she heard of CBT? Perhaps she might have suggested a few lifestyle changes, you know; more sleep, eat right, less shagging of married, high profile ex-hostages?

yep, sign me up for some of that!

What really overshadowed all of these ‘uh?’ moments though was the portrayed administration of the ECT. I know that my horror at this is entirely due to my own morbid fear of being carted off to be electrocuted until I’m a vegetable (but at least a sane vegetable), but did we need a graphic version of ECT on our screens? Was the fact that in real life anti-convulsants are administered prior to ECT, that the treatment is stopped after a only a few seconds to avoid the good old Jack Nicholson convulsions, just too inconvenient when a crazy woman fitting on a bed provided a wonderfully shocking finale?*  While I accept that in terms of realism Homeland’s version of shock therapy was an improvement on films of the past (although it should be remembered that many of those films were made at a time when ECT was a far more torturous procedure), only ever so slightly exaggerated, it felt almost worse to see it taking place so casually, just an addendum to a story.  At least those films – One Flew Over The Cuckoo’s Nest, The Snake Pit, Requiem for a Dream – pushed us to question the brutality of such a treatment.

To my mind, what was an opportunity to really explore bipolar in a form that would reach a wide international audience became an exercise in shock tactics, the realities of mental illness buried beneath a lot of fast-talking and crazed expressions, Carrie’s only trump card, the only thing that proved that she wasn’t entirely insane – the truth about Brody – was even snatched away by the writers (alright, they had to do it, I want series two as well) at the last minute. It felt as if Homeland went from offering the first realistic bipolar TV character to dropping a final curtain scrawled with ‘and this is why we can’t trust nuts’.

*information courtesy of several morbid hours a month spent checking out ‘all the things they might do to me’.

Incidentally if you’ve ever experience Electroconvulsive Therapy I’d love to hear your thoughts – did it work?  Who made the decision to administer ECT? If it was you, why?…

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Isn’t Mania Fun?

Although there are two ‘types’ of bipolar – bipolar I, marked by delusions and psychosis in the manic phase, and bipolar II, in depressive episodes are punctuated by milder hypomania – it seems that most of us have entirely different experiences within those two spheres.

For me mania, or rather what’s classed as hypomania, didn’t ever seem to be much of a problem.  It’s only recently that I’ve begun to recognise that periods or snappishness and irritability, my rather famous spendy episodes or the times that I get mad obsessed with something are indicative of of mania, rather than being, as I had assumed, judging them to be ‘negative’ as opposed to the ‘positive’ of mania, linked to my depression.

Now you’d think that I’d have known better but ever since diagnosis I’ve wistfully looked forward to a nice little bout of mania.  I’ve busied myself reading wikipedia medical research, imagining myself with this fabulous ‘increased productivity’ dreaming of this ‘decreased need for sleep’ and making grand plans for the day that the Manic Fairy finally visits; Redecorate! Earn a million! Clean the stove! Be the best parent EVER! Save the world…

Imagine my extremely predictable disappointment when I finally got my manic.

No amount of research prepares you for mania.  In all of my reading I’d focused on the positive side – I’d feel happy – and ignored the rest.  But once I’d realised that I was in a manic phase (it was my husband’s diplomatic silence in answer to the query ‘am I talking too much?’) all the bad stuff crawled on out of the woodwork and all my vain hopes for an amazing rest from the depression were dashed.

Here’s the thing.  Increased productivity is great if one can be productive one project at a time.  Instead I found myself writing thirty words, getting distracted and doing some online shopping, writing another ten words, then typing an email, going for an aimless walk around the house, another fifty words…I never focused on a single thing for long enough to make use of it.

This wild brain spin made me feel horribly out of control, which was the most unsettling thing about this, my first true hypomanic episode.  I’m lucky in that my episodes are comparatively mild and I’m able to keep myself from growing too grandiose or following through on too many silly plans and ideas, in fact I think the knowledge of my condition has helped me to keep myself on the straight and narrow – I’ve a strong feeling that bipolar could be to blame for an awful lot of my bad choices of the past (it’s as good an excuse as any right?).

The real surprise however was how much mania hurts.  I’ve spoken to many people over the years who, like me, imagined a great ecstasy high and I wish I could go back and put them straight now.

I imagine it’s the tension.  Whatever it is the longer my mania went on the more pain I found myself in – my jaw and teeth were sore and aching from the grinding and clenching, my spine and shoulders were stiff, even my thighs burned from the almost constant shaking of my legs.  Ecstasy high’s about right…but with none of the good bits.

It’s amazing, in a way, that I can still be learning new things about this condition, something that I suppose I’ve had all my life, and it’s sort of scary that I can still be surprised, despite experience and research, by what bipolar can throw at me.  As much as possible I try to treat anything related to my illness as a lesson because, surprisingly enough, there’s usually something to be learnt from it.  In this case: be very bloody careful what you wish for.  And keep a stash of chewing gum just in case.

How Social Networking is Working For Mental Illness

This week certain events have made me realise what a powerful set of tools we, the nutters, have at our disposal in Internet social networks.

First the level of understanding I witnessed on my Twitter feed following the suicide of Wales football manager Gary Speed was truly heartening even if one did feel that a handful of tweets were more out of a morbid desire to be involved or to have said something. Equally impressive was the quick work of mental health charities, many of whom I follow, in tweeting information related to suicide and depression in an attempt to quickly dispell myths surrounding Speed’s death and to, for want of a more appropriate term, ‘cash in’, using his death as a springboard to raise awareness amongst people who perhaps had given little thought to mental illness previously.

The second thing that made me consider the strength of social networking for mental illness was an accusation made by somebody at my partner’s place of work today.

I’ll make the story short as it really isn’t the point of this post.

Around three weeks ago I began experiencing by far the worst manic episode I have had since diagnosis. My GP promptly took me off of my usual anti-depressants to tame the crazy. In the meantime however he struggled to get in contact with my psychiatrist for a new, more effective prescription.

Yesterday on learning that there was still no progress after a week’s hard fall off of my regular drugs I lost it, calling the community mental health team in what I like to call the all-the-words-are-one-long-snotty-word tears to beg for an appointment which, bless the poor lady translating my slurps and nose blows, was immediately granted.

This meant my husband would need to leave work to look after the kids and, to his concerned mind, me. He did exactly that. I went to my appointment. I got my shiny new lithium and the promise of a lifetime of blood tests and thyroid problems.

Today my already stressed husband was pulled up by his workplace for lying. Because I was cheerfully chatting on Facebook and Twitter whilst between appointments and in waiting rooms, the only conclusion drawn from this was that he lied to get out of work or I lied to him about the illness.

Make of that what you will but I mention it as an illustration of just how wonderful a tool something like Twitter can be.

No sooner had I made my 4sq check in at the hospital (I WILL BE MAYOR OF CRAZY TOWN) than a good friend tweeted me; ‘you ok?’. Having reassured her that it was nothing she needed to rush round with my Valium and a cup of cyanide antidote for, we continued making plans to go to the cinema later this week.

I posted some stuff about music and did a Shoe of the Day post on my other blog , probably talked about owls or Leveson…whatever. It helped. It distracted me.

In this way Twitter, and the members of its social networking family, has been instrumental in keeping me sane over the last few months.

You see a large part of my problem is social anxiety, an inability to deal with day to day interactions. So on days when I can’t face talking to the woman on the till in Sainsburys or picking up the phone, even to my best friend, being able to merrily chat to people makes it all the easier to feel normal and connected with the rest of the normal world.

Twitter has even led to new friends – people I’ve got to know well before having to take the plunge and actually have one of my nonsense red-faced conversations with them. Some I’ve still yet to meet but would consider more than mere acquaintances, others I now regularly spend ‘real’ time with including the concerned friend I mentioned above who despite living just metres away became a ‘tweep’ first before flushing me out of my hole.

I’ve also met other people with bipolar through the web, had conversations with representatives of charities such as Mind and Time To Change and generally learnt more about my condition while also being able to treat it with a degree of honesty I’d shy away from in a face to face conversation.

But most important is the sense of purpose and distraction that social networking can give to a person with mental illness. Pre-Twitter what would one do in the middle of the night warding off a panic attack or fighting insomnia? Now the answer is simple – post ‘can’t sleep. Fucking insomnia!’ and receive three replies from people you sort of know all over the world; ‘me too, need…more…sleeping pills’, ‘try getting up for half hour & trying again’, ‘get off your iPhone then you dozy cow!’ etc…

Or even better are those moments when you engage yourself in a conversation about something entirely unrelated. I’ve distracted myself on numerous occasions debating the relative merits of cats and dogs, discussing international bacon festivals and naming the fourteen top moustaches of the twentieth century. All conversations I’m pretty sure busy real life friends and family don’t want to be pulled out of work for but that there’s invariably an American/home worker/abuser of lax office internet policy available for.

Whatever its faults – and it has ever so many – I think that social networking has probably saved a life or two. It’s undoubtedly saved my sanity more than once. Not only that but without Twitter where would I find an captive audience for the tale of running out of shower gel and using my son’s Ben 10 Foaming Alien Slime to wash with?

Exactly.

A Good Friend is Cheaper Than Therapy

I originally posted this on http://hoola-la.posterous.com  …

I read something this morning: ‘Bipolar people tend to say sorry a lot’.

It’s very true, I tend to apologise often, usually for things that are out of my control or weren’t my fault in the first place. I’m learning that not everything is my fault – it’s something that all bipolar people, or those with any depressive illness could do with learning but it just isn’t that easy when that frayed electrical connection in your brain is telling you that you just can’t get it right.

Being in a relationship, any kind of relationship, with a bipolar person is difficult, but I’ve been lucky enough to hang on to some amazing amigos; incredibly strong people who have stuck by me from way before my diagnosis, when there was no medical reason for my being a poor excuse for a friend. Those people know who they are and they continue to provide the most incredible support. I only hope that I’m now as good to them as they continue to be to me. I think I am – bipolar folk are kinda keen sometimes.

On the other hand I have made endless fleeting friendships, ones which fizzle out as quickly as they begin. The way these friendships end is hard, really hard. I can’t speak for others in my situation but I think I tend to shed more friends, more quickly than your average non-crazy. See, for most folk picking up the phone to say hi is an easy thing, as is walking in to a pub full of enthusiasm, sitting down and starting a conversation with somebody you know and love. Not so for somebody in a depressive cycle – talking to somebody you care about is harder than talking to a stranger – what they think matters, and you, well, in those moments you’re not good enough.

And a manic cycle? Those are the most misunderstood. Those times when I’m grumpy and snappish or the times that I’m making inappropriate comments and offending you? That’s all part of the mania. That’s the bit that’s hardest for the friends, the bit when the person you know isn’t the person you know, or when the person you thought you knew arrogantly thinks they know you too well, know that you’re judging them, talking about them behind their back, that something you’ve said meant far more than it did.

Mania. It all goes a bit Cyd

These are the times I lose friends, during those manic cycles. And I’m what they call Rapid Cycling, so it happens a lot.

Good friends though, the ones worth hanging on to like the life rafts, perhaps don’t even realise they are are the ones who ride the storm with you. Some read about bipolar, or they ask questions – they try to understand and it makes them more forgiving. Others will step back and let you ride it out yourself, they’re the ones that you know are there waiting in the wings to make things better, who know you well enough to know when your actions, your behaviour, is not ‘you’.

That’s not to say that bipolar is an excuse for being kind of a bitch. It really isn’t. I’ll still say sorry when I’m wrong, of course I will. And my bipolar doesn’t excuse every bad decision, mean comment or just plain horrid thing that I might do. But at the same time I’m not going to apologise for you, the friend who only wants to be a friend when the weather’s fair (is this weather analogy getting too much? I think it probably is).

I’ve noticed that those of us with depressive disorders tend to attract a certain type of person, for whom the term schadenfreude was obviously coined. Those are the worst ‘friends’ for a bipolar person to have, the ones for whom your problems make theirs seem less so. They’re the difficult ones though, the ones you convince yourself are the good, because they’re there during the bad times, sympathising and tutting in agreement, reporting back to other friends about your bad state of mind (perhaps with a glimmer of pride at being the one able to do so). You know what I’m getting at here…

Please understand that I’m not pointing the finger, I describe these people, these non-friends, without anybody in particular in mind. I’m well aware of the old ‘point one finger and three point back at you’ adage.

The friends I’ve lost I do feel sad for, I miss some of them terribly – indeed a few recent losses have been particularly hard, having the increased self-awareness that comes with diagnosis and still not understanding the way in which one can be dropped quite cruelly with no explanation (in this regard losing friendships is so much harder than being dumped don’t you think? At least the end of a relationship proper demands a certain degree of closure). However, the pain left behind by the lost friends is tempered by the knowledge that they weren’t good enough; that they didn’t take the time to understand, didn’t have the capacity to forgive or didn’t have the patience to press pause while I cycled in the wrong direction. It was them, it wasn’t me, that was ultimately not enough of a friend.

If you’re somebody I know, reading this now, you deserve a medal, possibly several. If you’re a stranger and you have a friend with bipolar (I can’t think why else you might be here) my only advice is to remember that while times are often bad, the good times are better because, in our own little way, those of us with bipolar are always trying, one way or another, to say we’re sorry.