“If you can move through life without psychiatric medication, that is a privilege. If you can enjoy and celebrate your emancipation from psychiatry’s ugly clutches, that is a privilege”

David Mordecai’s #MadCovidDiaries – January 2021

TW: Mania, Advanced Dementia

I am tired (but cannot sleep). I am angry. I am frustrated. I am deeply disappointed. And I am grieving. Apologies in advance that this will be more disjointed than my past MadCovid Diaries entries.

My father is at the end of a journey my family has been warned about for years. The final stage in advanced dementia is often one in which the person stops eating. In my father’s case, he hasn’t outright stopped (yet). But the rigidity and loss of muscular control that accompany his form of dementia make his ability to swallow, or take anything into his mouth, very difficult for him. And the risk that he will aspirate/choke to death grows.

I’m a middle-aged gay man who lived through the peak of the AIDS crisis. I’ve known a lot of grief. It doesn’t get much easier, but one learns to cope through familiarity. And I am most certainly coping. Coping does, however, involve periodic lapses into wild, howling fits of crying that I know to just let wash over me.

So, that’s one part of what is going on.

Then there is the political climate in the US, the UK and certain provinces in Canada, including my own. In different but consistent ways, conservative politicians are borrowing from a populist playbook in order to privilege self-interest, money and wealth over health. They mobilize people’s fear and pain to animate our worst tribal instincts. They intentionally manipulate and distort the truth to harness the social power of sexism, racism, ableism etc., to serve their own power and greed.

My last trip into mania and near-madness gave me some deep insights into the nature of social power that I am still unpacking. I like to talk about the experience as #FeelingFoucault. I see what is happening politically in the world, and I am very concerned.

The combination of emotional vulnerability, given the situation with my father, and the analysis I am bringing to world events based on my last experience of mania is a potent one. I am experiencing an emotional flux along with a form of insight which in combination are creating a pull toward mania of a kind I can’t ever remember experiencing before.

I do want to be clear that I am not manic. Not even hypomanic. However, after many months of relative stability I can see and feel the subtle signs that my clinical mood wants to shift: a heightened awareness of and sensitivity to beauty, a broadening of the idea horizon. New insights enthrall me. I drop short words from email messages. Mania is still a long, long way away, but I can see its sparkle nipping at the heels of my thinking. And, of course, it is deeply disrupting my ability to sleep.

When this has happened in the past, I have not had to worry. I don’t love antipsychotics, but if needs be, I am quite prepared to take them, and they have always worked to quickly shut down any tendency towards mood elevation. And while hypomania and even mania can be enthralling–and laden with real and intriguing insight–mania almost destroyed my life once, and I have no desire to take that chance again. So I take whatever drugs I need to shut it down.

Unfortunately, last year I started feeling strange sensations in and around my mouth and had subtle difficulty speaking. At first I thought it was a stroke. Eventually consultation with a specialist suggests a likely culprit is early Tardive dyskinesia (TD). I had adverse movement effects the last time I used aripiprazole on a maintenance basis. So now, although I might take them in an all-out emergency when I am completely detached from reality, using antipsychotics to curtail my rising mood leaves me fearful of furthering TD.

Any psychiatrists reading this will ask what maintenance meds I am on, and I will say none. I’ve used lithium, lamotrigine, lurasidone and aripiprazole on a maintenance basis, some of them for years. The antipsychotics can definitely manage and prevent what I am experiencing, but neither lithium nor lamotrigine does completely. I’ve always needed an adjunct to help at times like these. And for day-to-day mood maintenance my doctor and I have in the past agreed that a daily mood stabilizer is generally not necessary. However if this continues for an extended period I may well resume one.

I was fortunate to have an extensive check-in recently with my GP psychotherapist (the above doctor) and we have a medication solution that I am so far comfortable with. It’s not my intention to cause concern or distress in others with what I am describing. I will be fine.

However, to add to all of the above:

Twitter, a place where I find considerable support in part thanks to @MadCovid and #MadCovidChat, has recently been featuring the self-indulgent ideas of some ‘critical psychologists’ who believe that there is no biological basis to bipolarity. This may be true for some, but it’s a tricky position to believe exclusively.

I see (admittedly, old) tweets on Twitter in which an influential member of the British Psychological Society draws a mental health charity over the coals for talking about ‘bipolar disorder’.

I see consumer survivors and members of the prescribed harm communities coming to her defense.

I feel my head wanting to explode.

I am reminded of Akiko Hart’s important piece on Pursuing Choice, Not Truth.

I understand how ugly and unpleasant psychiatry can sometimes be. An incompetent psychiatrist ploughed his way destructively through my life for a year when I was misdiagnosed and mistreated, and what I went through is nothing compared to what happens to a significant number of people (and even if that number is one, one person is significant). I completely believe and empathize with those who have been deeply and possibly forever harmed by careless prescribing and electroconvulsive therapy. I know that I am very privileged to have had a journey through psychiatric care that so far has not harmed me to that extent. I am privileged that the meds do help me, as much as I hate some of them.

What I am asking those whom I have heard described as PTMF evangelists to understand is that if you can move through life without psychiatric medication, that is a privilege. If you can enjoy and celebrate your emancipation from psychiatry’s ugly clutches, that is a privilege. In no way are trauma and abuse privileges, however, in a peculiar way, being able to be certain that your biology has nothing to do with your madness is also, yes, a privilege.  

One of the things about clinical elevated mood is it tends to heighten my capacity for pattern finding. (Many, but not all, people who have experienced mania can relate.) It seems far-fetched, but *some* of those so-called critical psychologists who are animating the community of people who have been deeply harmed by psychiatry are not so different from conservative politicians who are manipulating those who have been grievously harmed by years of austerity and globalization. In both cases, they are influential leaders advancing a personal agenda that may not truly align with the interests of those they claim to be trying to help.

I look at my dying father grappling with the final stages of the degeneration of his brain, and I wonder at the intricate relationship between biology and mind. I am astounded at the arrogance of those who could so confidently dismiss the biological basis of bipolarity.

I am angry, and I am tired. But I cannot sleep.

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