Under all this sound and fury

Sharing the stuff I wrote in my early 20s is probably a terribly embarrassing idea, but it does give some kind of insight into my mental health across time. And at least I’ve not shared all the stuff I wrote when I thought I was Jesus.

I’m moving out of London soon – this city might not send me crazy, but leaving it sure will help keep me sane. At least for a little while. Now seems an opportune time – I’ve no job holding me here, my studies will either finish soon or be postponed for a year. I’ve family in Sheffield. Family is good for me, as are the Pennines, as is home.

I’m being unusually pro-active about it – usually when moving I leave everything to the last minute, but I’m seeing this as a chance to declutter. You go through life, you pick up so much crap, so much stuff. I moved down here with a rucksack… now I’m going to need a car for my return.

Still. May as well get of as much as I can stand to. Almost all my books are going, and I suspect a fair few clothes will end up with charity shops. But of course in clearing out you find forgotten bits of life. And if you have a habit of writing – sometimes in fits and starts, sometimes consistently for years – you find a lot of forgotten bits of life. All dusty and discoloured. And with hindsight you can return to all those years ago, with new eyes, and wonder how some things managed to escape your attention for so damn long.

What follows are a few brief extracts – with the exception of the first one, which I’ve reproduced pretty much in its entirety since it does such a good job of evoking my frustration, confusion, and despair at the time – and how much the city (Leeds) was getting to me.


Jan 2002

(Age 20)

Clever dykes and clever dicks, how to get ahead in relationships. How to not care what women want. How to worry over what men want; how to walk past beggars and only feel a twinge of guilt, how to ignore Big Issue vendors.

How to dance and hardly care who’s watching.

“You know about helping yourself?” the woman in the cafe asks.

No.

“Yes”

The exams are coming and I’m too busy smashing crockery and whimpering on the kitchen floor to do anything about it.

And outside the rain’s still pouring and the poor bastards with no homes to go to are crouching by the light, wrapped in sodden blankets with nothing but a handful of coppers in their McDonald’s cups.

And I walk by thinking poor bastard.

And I walk by thinking I want to run away.

And I walk by thinking maybe this next car.

And I walk by.

I’m plummeting. I can feel the world slip by and I slip down.

No, really. I can.

Nausea and vertigo. I wish I could throw up.

I don’t feel too good.

I’m breaking up. I no longer relate to myself. This time it’s serious, I don’t think we’re getting back together, but I don’t care. Who needs him anyway?

“Do you know about helping yourself?”

 In Border’s the coffee tastes of vanilla, and the lights are bright and anonymous.

Anonymous is a word for limericks. A nonny mouse.

My head still hurts with awesome pressure and my legs are still weary tho I don’t know why, The world is still swirling in my head.

It’s only 7:30. I’ve no desire to go home. I’ve no desire to communicate in anything other than wails and tears and screams.

Whale ant ears and cream.

Let me out.


Laugh and the world laughs with you;

Cry and you cry alone.

For this sad old earth sees little of mirth

And has troubles enough of its own

 


Summer 2002

(Age 21)

For the first time I can remember, I look into my future and every part of me, every fibre of my body and soul is saying yes.

Some of it is in baritone, so deep it’s a feeling more than a sound. Some so excited the sound is a babysqueal of joy. Some are so simple it’s as if the answer is so obvious it’s a non-question.  Now it all looks so simple. All the fear has left me now.


November 2007

(Age 26)

I’m flirting with depression again. Flirting, because it comes and goes, and I’m still functioning OK, for the main part.

Before, I’ve just got wound iup and more depressed about it. That’s a bad strategy. Before I get too bad and wound up, I need to deconstruct this and take some pro-active action.

  1. What do I think has triggered this?
  2. What maintains it?
  3. What makes it worse?
  4. What can I do?
  5. What can I think?

February 2008

(Age 27)

I’m sorry

I’m sorry

I’m sorry

I’m sorry

I’m so sorry


March 2009

(Age 28)

I’m sat on my bed, in my tidied-last-week (becoming messy) room, listening to Gaydar Radio.

I’m feeling OK.

Or, something’s making me feel OK. 40mg of citalopram might be involved. The exercise I did yesterday might be involved. And the alcohol I drank last night and the poor sleep I’ve had and coffee might be involved. Brains are complicated like that.

The music on the radio is sending ripples of hypomania through me. Am I bipolar or is it the drugs? That strange, pressured joy and expansive bliss.

Expansive bliss is something I’ve had for years, now and then. The first time, in mum and dad’s garden, on a summer evening, with the dark sky and violet flowers and sweet air.

E x p a n s i v e  B l i s s


March 2009

(Age 28)

I miss my past. Because in my past I only look at the good bits. In my memory everything was perfect.

Who are you, Phil? Under all this sound and fury, who are you? Can you stand still?


June 2009

(Age 28)

Sat upstairs in the Wellington, drink by my side and pen in my had, trying to write poetry and only finding commentary.

Memories insistent as rain, I shudder sometimes from little earthquakes. You don’t know where you end and the drugs begin. All those ticktock phrases gone, evaporated in the sun; all those loops, looping loops lost. Left with memories, soft and insistent as raindrops on skin.

I’m feeling good, ultimately. Sanity is underrated.



 

In June 2012 I visited a friend in Cardiff. He was worried about my mental health and invited me up for a break.

Leaving, we hugged, and I pulled him close, tight, kneading his flesh. Began to sob, hysterical.

I’m going to do itI’m so scared, I think I’m going to do it.

The next day I was picked up by the police and taken to hospital.

Life is full of ups and downs, as they say.


 

‘Ticktock phrases’ and ‘looping loops’ refers to the persistent, insistent thoughts and phrases of violence, suicide and grief which beat obsessively in my mind when I’m depressed. ‘Memories soft as rain’ refers to the side effect I get, occasionally, with antidepressants – their strange habit of bringing up old memories, neutral, long forgotten memories, often of childhood.

The promise of lust

Partial list of side effects from citalopram information sheet I don’t know exactly when it shifted, and I definitely don’t know why. I tend to put a definite cut off around 2008, since the 2008-09 episode was so profound, lasted so long, and smothered me; like sleep, under morphine.

At first I blamed the drugs. That was comforting and easy, because after all a side effect of SSRIs is loss of libido. It also held out the promise that once I was off the drugs, I’d be up and running again. I was willing to put up with a flatlining sex drive for a while, for the relief the antidepressants gave me. They were only temporary, after all.

And then I came off the drugs, and I looked forward to the promise of torrential lust. Being young and gay in London with no strong desire for sex is… frustrating. I wanted that part of my life back. So I waited, and I waited, and it never came.

Oh sure, I could get drunk and horny. But that’s missing the point, isn’t it? Drunken lust is clumsy, grasping and loose. Temporary, and soon forgotten. Being young and gay in London with no strong desire for sex is more than a little alienating.

I still blamed the drugs, or maybe I blamed the depression, or both. Blamed some kind of permanent rewiring of the circuits of sexual desire. Maybe they’d burned out? Maybe they’d atrophied? We live in a culture saturated by sex – gay subcultures especially are sodden with it. But for all that, we seem to have little real regard for it. For most of us, sex is important, beyond hedonism and lust and beyond even passion. It’s important for contact, for happiness. For relationships and belonging and feeling a broad and deep range of emotion, sensation.

And I wasn’t getting any.


“Loss of libido” is thrown away in the patient information sheet which details side effects of SSRIs, alongside “failure to reach / maintain an erection (in men)”* and “Anorgasmia (failure to reach orgasm)”. I guess in the grand scheme of things, these aren’t profoundly worrying side effects – the other drug I’m on, lamotrigine, lists Stevens-Johnson syndrome (a potentially fatal loss of skin) and disseminated intravascular coagulation (DIC, AKA Death Is Coming) as it’s potential side effects. Yes, I’d rather have no sex drive and shit orgasms than die horribly from my skin sloughing from my body. Still. Hardly a fair comparison.

Sex is important. And when you’re prone to depression, not having a full – or any – sex life, and thus no romantic life, is dangerous. It denies you a source of pleasure, emotional soil in which to grip your roots to the world. “Protective factors”, in the dry but honest language of a psychiatric consultation. The fewer roots you have the more likely you are to wither. The easier it becomes to simply take the hand you’ve been dealt, and fold.

Sex is important. I really, really don’t think the wider psychiatric community appreciate just how important it is, largely oblivious to how antidepressants can deeply wound a life.


Of course, I’m human, and humans excel at making simple things complicated. Maybe the depression led to a plummeting libido. Maybe SSRIs turned down too many switches inside my head. But people are more complicated than just brains. After so long without a shag, the whole issue takes a life of it’s own, entwining with sexual confidence and body confidence, until it becomes impossible to know if you’re not having sex because you don’t want to, or because you’re afraid to.

I hope this problem is nice and simple and neurological. I hope my bottomed out libido can be blamed on a zapped out reward pathway, or a scrambled endocrine system, or anything other than high level psychology. Because if it’s up to psychology, I really can’t see it being resolved any time soon. Sex is important. Without it I don’t meet guys, I don’t date. I must be the only gay man in London who has never met anyone off Grindr. Seriously. My last online hookup was in 2008. This. Is getting. Tiring.


“Would you be open to a mood stabiliser?” The psychiatrist asks.

I’ve been rumbled. They want to take the hypomania from me.

“Which one?” I ask. They know I study neuroscience. It’s in the file. An awful lot is in the file.

“Lamotrigine”

I’ve heard of it, but beyond it being a mood stabiliser I know nothing. I don’t want the sluggishness that can come with some psychiatric meds (paroxetine destroyed me with sleep; and I’ve seen the effects of olanzapine – an antipsychotic – second hand). Will it place a final nail in the coffin of my libido? I’m wary. I want to know it’s mode of action, I want to know if…

“Like I say; I think the SSRIs work because they make me slightly hypomanic. If you take that away… What’s left?”

He reassures me; “just a trial”

It’s ultimately up to me. Naturally I go online and look up the mode of action (voltage gated sodium channel blocker, calcium channel blocker, glutamate modulator). I look up personal experiences.

Rise in libido.

Not everyone, not all the time. And sometimes the reverse – maybe it could be the final nail in the coffin. And sometimes the rise is due to activation of mania, sometimes fades after a few weeks. Still. It hangs there, glowing on my iPad screen. The promise of lust. Rise in libido.

I say yes.

I take the pill.


*Seriously, this is how it’s phrased. I love the fact they felt the need to specify.

Always be beautiful

I feel…

I feel. You don’t know, you can’t know. How this feels. I feel.

Like…

Like the world…

No.

Like my heartbeat… Like my soul…

I feel the world, my heartbeat, my soul. I see this majesty, this glorious, wild, passionate world. I want to grab, to pull, to claw the world. To kiss. Deep. To leave my marks, red and raw and burning. Bloody, primal, rare.

To devour. This world dripping with promise and passion and fury and chaos and love, and love, and love, and lust.

I step from the pharmacy, holding a blister pack of lamotrigine in my hand, and look to the sky; a sunset glorious and impossible and free. A breeze teasing and sensual, and playful, and exultant. Clouds, golden, blazing.

I step from the pharmacy and look at the blister pack in my hand. Do you know how it feels? You can’t know. To feel so miserable, to feel to wretched and useless and bleak and ruined, to then see the world blossom out in breathless beauty; to move so swiftly from putrid misery to… to…

To this.

To glory.

And to be told this glory is folly, to be told to swallow these pills to take the fierce, untamed beauty from the world. To be told you must turn down Nirvana. Attenuate Heaven. You can’t know.

I walk, I smoke a cigarette. Catch the tube.


You can only hide so long. I suspected, ever since 2008, that the reason SSRI medication worked ‘so well’ for me was that they pushed me into a kind of hypomania. Paroxetine threw me into wild abandon – true mania, light speed and ecstatic and frightening and free; Sertraline, giddy and loose, the time I decided I needed to start dealing shares and learn Latin. Citalopram… Citalopram, like the bed of baby bear, just right. Citalopram, not too wild, just wild enough.

And yeah, sometimes I felt so free I could fly. Sometimes, even without the drugs, I could embark on wonderful new ideas and projects and schemes and it would always, always be beautiful. And I could dance in the street and dance in the gym because honestly, honestly, sometimes I can hear the music and feel the music, feel the music like a kiss. Not the gentle kiss of romance but music lustful, electric, abandoned; which grabs your neck and your body and pulls you in, devouring, devouring, hard and dangerous and fierce.

You give too much away, eventually. The records they keep are surprisingly detailed. “Would you be open to a mood stabiliser?” the psychiatrist asks. I say yes, eventually, for my own nefarious reasons.


Hypomanic episodes have less than ideal long term effects. Cognitive decline, possible neurological disruption. Still.

Still.

You can’t know how it feels. To be told this has to be taken from you, for your own good. The blinding brilliance of hypomania, when the world makes sense and you make sense and everything, oh everything is glorious, to be told everything that is glorious is a lie, the real world is a watery reflection, the real world a muted song. Take this pill. Save yourself. Turn down the world.

Would you take the pill?


I get off at Waterloo.

I take the pill.

Well done there

Leaving aside the fact I’m off to Birmingham Pride this weekend, my alcohol intake (i.e regular slovenly insobriety) has slumped back to normal levels – well done there.

And aside from several large slabs of chocolate, last night’s Deliverance burger, chips and chicken wings extravaganza, an upsetting number of impulse detours to McDonald’s, and whole 6 pack of breakfast muffins the other morning, I’ve not had any self control problems at all.

#FML

(Note: Again, this is one of those occasions where the ‘physical’ side effects of my medication – in this case, reduction in hunger pangs – is easily overridden by the ‘mental’ side effect of impulse disinhibition. This doesn’t happen with my sex drive, where I’d actually ENJOY it; because biology and psychology both have a wicked sense of humour)

Slogged

So, just over a week into citalopram; the nausea has subsided, the strange yawning-stretching-crawling pulses are becoming more infrequent. My teeth still chatter, slightly. The turbulence of takeoff.

Sleep. Sleep is one of my two big sticking points with SSRI medications. I’m naturally a lark, one of those insufferable early-to-bed, early-to-rise people, up by 8am at the latest on weekends, unable to lie in. Except while on meds.

Antidepressants increase bed gravity like you wouldn’t believe. And this is the first time I’ve taken them when I’ve not had to get up first thing (to get into work), which has allowed me, for the past few days, to lie, just lie, and bob on drifts of sleep. Which means this is the first time I’ve realised – this is a terrible thing for me to do!

If I can’t get started first thing, turns out I can barely get started at all. I climb out of sleep and bed hazy and befuddled, clunk aimlessly downstairs and muddle about for a few hours, until I can no longer put off going into the lab and into the gym; shove myself, sulking, out the house. Wonder what the point of it all is.

This morning I forced myself up; I need to get to Dean Street for a checkup anyway, I’ve got shopping to do and then (obviously) lab and gym on top of that. And it’s not as if I’ve nothing to do – a mountain of study which I’ve been ignoring, my room is a tip (a few weeks worth of depression will do that). And Jesus, I feel better for getting up. Must remember this. Must try harder. It’d be absurd if a side effect of the antidepressants I’m taking made me more depressed…

Mirtazapine, intense as in

Peaches! It's a visual metaphor, maybe.So last week I asked for my prescription to be changed.

I’ve been on citalopram for about a year now – it’s is a common-or-garden antidepressant which has a very similar cellular action to Prozac – they’re both what you may or may not know as ‘selective serotonin reuptake inhibitors’ (SSRIs). I won’t go into the nuances of SSRI treatment here, save to say they work to an extent, and for some people more than others. I’m fortunate – citalopram seems to work very, very well with me. So why change?

Side effects.

The side effects of SSRIs are usually not too bad – the worst I’ve ever had, or seen anyone have, is an immense tiredness, which can be enough to lead people to quit. But the tiredness I experience on citalopram isn’t anything troubling to me; I need an afternoon nap and that’s pretty much it. Given how profound and dangerous the depths of my depression can be, a few piddling side effects really aren’t worth worrying over, not in the heat of the moment (or, rather, the depths of the dark).

After a while tho, when all is sunny and well, what had been niggling side effects take on a change in character; specifically, the rock-bottom libido I’ve lived with for a few years now, notwithstanding alcohol inebriation. SSRIs are known to sometimes muck about with sex drive, and after mirtazapine was brought to my attention I thought it worth a punt.

Even so, I don’t have great hopes for this ‘working’; that is, delivering some miraculous return of my sex drive. Libido is complicated and impacted by a whole range of factors, from depression itself to past sexual and romantic history, confidence, self-perception, all the way up to culture and subculture, and perception of one’s own role within that wider context. Even if my predicament was initially brought on by a simple chemically-induced neurobiological change, it will be far from simple now. Brains are complex, and people even more so. Still, this is low hanging fruit (fnar), and you have to make a start somewhere – this is a start, of a kind.

And what a kind! My GP looked surprised at my request, pointing out that mirtazapine is usually prescribed for more anxious-depressive types, those filled with a worrying energy. The drug, he explained, can have quite profound sedative effects. Take at night. You might have difficulty waking. Dreams may come.

Dreams did come, and they’re still coming, though I’m told they’ll eventually, probably, fade. Some claustrophobic, some vertiginous, some icy and frightening, all suffocating, intense. Intense as in seeming profound, only to tatter away with a moments thought. Intense as in teenage crush, primal and primary, confusing. Intense as in shrooms, hilarious because, hilarious because hilarious, because. Haunting, and like ocean waves dragging you down as you wake, as you surface, only thrashing and gasping and drowning again into dreaming, and again, and again into dreaming.

The first day, my eyes opened and I got up, I drank strong coffee and more strong coffee but never really awoke, napped for hours before exhausted went to bed, another twelve hours, awoke to dreaming, awoke to dreaming, awoke.

The second day – strange and a world full of echoes and space, but more awake. I think I’m lucky – the tiredness fading fast and swift now, even if the dreams still boil away at night; while waking is still a confused surfacing it’s getting easier. During the day I can write, read, I can even talk and think, and it’s been less than a week. That’s some quick neuroadaptation!

Maybe I’ll even get my libido back.testosterone