Author: theborderlinestories

Sectioning: Part 1

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The first time I was taken to A&E, I was hallucinating very intensely. I remember telling the nurses in the ambulance as they took my blood pressure and asked me some questions that Princess Diana was my mother, as my own mother stood right by me. I didn’t recognise her.

I don’t remember much of A&E, except that I was exhausted and kept trying to sleep, but the hallucinations wouldn’t let me. I had no idea I was even in a hospital. I must have been assessed by the psychiatric liaison team at some point, and eventually they decided that I had to be sectioned (even though I didn’t realise this was happening).

Sectioning is the informal term for when someone is compulsorily detained in hospital in accordance with a provision of the Mental Health Act 1983. I had been sectioned under s. 2(2). The provisions of this state:

(2)An application for admission for assessment may be made in respect of a patient on the grounds that—

(a)he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and

(b)he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.

Given that I did not even know that I was in hospital, this was undoubtedly the right decision.

However, sectioning for me (like many others) was a traumatic experience, because I could not understand where I was or why it was happening. I would have appreciated having leaflets left for me in my room – to peruse when I was more lucid – that explained the process. But this is not currently a requirement, and so I was very confused and scared when the nurses bluntly told me I could not go outside when I asked. I was also, due to internalised stigma, very reluctant to accept that I had any form of mental illness.

Even more shockingly, when I was discharged 10 days later, this was with no diagnosis and not even any antipsychotic medication – I had fooled the doctors into thinking there was nothing wrong with me despite my family members attesting that there was. What is completely bizarre to me is that I literally could not recognise my own mother, so was this evidence of my condition on admission completely disregarded by the consultant psychiatrist?  

The ensuing lack of support led to another acute psychotic episode after I was discharged from hospital, when I was finally put on medication, referred to the Early Intervention Service for Psychosis and given a diagnosis of an acute and transient psychotic disorder.

Of Delusions and Hallucinations

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I have the distinct memory of staring at the wallpaper in my parents’ living room sometime towards the end of September 2017. This unique wallpaper comprised different stills from famous old movies. I remember looking at it and having the strangest feeling that the people in the black and white pictures were looking back at me: their eyes followed me around the room. And then, looking at the painting of boats moored in an old fishing-village which hung proudly in the same living-room on a wall adjacent to this wallpaper, I remember being completely flabbergasted when the boats in the painting started to move. I took this as bona-fide proof that ‘Harry Potter was real’ and that I had also simultaneously been blessed with super-powers. At one point, I even thought that the President of the United States was after me because I could see through walls.

People’s faces melted and morphed before my eyes when I would go out for walks to town by myself, usually resembling either bug-eyed, blown-up benevolent cartoons, or twisting into the features of the Joker with sickly painted drooping smiles. I heard a deep booming male voice which I called ‘the voice of God’ and spent a good month or so believing I could heal people with the power of touch. ‘I feel like Jesus’ I exclaimed to my worried parents, bouncing out of the house with a massive smile on my face.

My disorder is polymorphic, which means my hallucinations and delusions can change from day to day or hour to hour when I am very unwell. This meant it was very obvious to everyone else that I needed to see a doctor, and fast.

But I thought the doctor was going to shoot me, and that hospitals were a hoax. This was part of my ‘Matrix’ delusion, as part of which I would literally see green code materialising before my eyes, falling in a stream of symbols from ceiling to floor.

I have never experienced such a rollercoaster ride of strong emotions before. It was emotional turmoil of the most intense kind. One minute I was as high as a kite, laughing manically to myself, and the next, I experienced such intense fear and anguish that I would lock myself in my bedroom and bury myself under the covers, for fear that Agent Smith was waiting outside the door waiting to blow my head off.

When the A&E nurses showed up at the house one evening, I remember I only conceded to going with them because they had elven ears and because they had ‘kind eyes.’ It was an observation fuelled by delusional beliefs, but nonetheless, one that would save my life.

Internalised Stigma

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I touched on internalised stigma in The Middle. I was not expecting it to rear its ugly head in more recent times, since I have taken quite a few steps in terms of acknowledging my mental illnesses, including coming out to family and friends on Facebook last August. But, following a call to a mental health helpline last week, I must admit the battle in my head in terms of fully accepting – rather than merely acknowledging – my mental illness still continues.

Last week, I quit my job, and asked that the statutory period of notice – which is rather long in my profession – be waived for health reasons. I agonised over this decision for weeks, cried most days out of guilt and was paralysed by crippling anxiety over what to do. But, for quite possibly the first time in my life, I prioritised my mental health over my career.

What, then, was the ensuing problem? Surely, the fact that my GP had signed me off sick with low mood and anxiety would be enough to put my mind at ease for a little while as regards the guilt of leaving my profession without sufficient notice. But no, internalised stigma came knocking once again.

‘How do I explain myself to my boss?’ I asked the mental health advisor, clutching my phone to my ear in between trembling fingers.

‘You don’t need to – the medical certificate is enough.’

‘But – ‘

‘Think about it this way. If a colleague broke both arms in a terrible accident – let’s say it involved a bus – would you expect them to give x weeks of notice? Would you expect them to go over the accident in excruciating detail?’

Of course not, I answered. There is no difference in either case – both are illnesses, both strike without warning, and in both cases, the person directly affected is not at fault.

Logically speaking then, why was I stigmatising myself over my illness?

It is a complex issue, and one which I continue to wrestle with time and again. Perhaps it connects to the invisibility of mental illness. From a cursory glance at me, you would be none the wiser of my diagnoses.  But if I had a cast, or crutches, it would be immediately apparent that I was undergoing treatment. Sometimes, even I forget that just because you can’t see my illness, that doesn’t mean that it doesn’t exist.

Internalised stigma also links to the fallacy that mental illness, being so inextricably bound to one’s state of mind, is not as such a ‘real’ problem. Rather, it is one that one should just be able to magically ‘get over,’ through exerting the sheer power of one’s will. This fallacy is premised on the idea of control – that someone always has agency over their illness.

But, long-term mental illnesses, like a trespasser at a birthday party, do not ask for permission before they materialise on your doorstep. It takes time and effort to keep them at bay. And sometimes they can even insidiously find their way into your house. They may have already helped themselves to a martini in the kitchen, used your bathroom and switched your meticulously crafted playlist for their own before you notice their presence.  

Early Warning Signs

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I was at a party, one of my closest friend’s birthday parties to be exact. Like the fizzy drink in a bottle that has been shaken vigorously, my anger was about to burst beyond the flimsy lid that had been feebly containing it until now. A man I did not know grabbed my waist as I waited for a drink at the bar and swung me around to face him and that led to the lid rocketing off into space. ‘What the f*** do you think you’re doing?’ I more or less screamed. Cue a further round of expletives from yours truly. Cue aforementioned man looking very confused, stepping back in bewilderment. Cue my friend looking at me with a concerned expression on her face.

This was very out-of-character behaviour for me. I think I attempted to start about three fights that night, verbally, and swore a great deal – I would have given Gordon Ramsay a run for his money. The same thing happened at another party a few weeks later.

My friends were really worried about me, and suspected I had some form of illness because I had been acting like a completely different person. I was completely oblivious to all of this, of course. I saw myself as undertaking some sort of crusade against men (one of my many delusions). This was September 2017, two months after I graduated but around a month and a half before I was hospitalised.

Let’s pause for a second here. What I was experiencing here were early warning signs of a psychotic episode. Generally speaking, they include:

  • A worrisome drop in grades or job performance
  • Trouble thinking clearly or concentrating
  • Suspiciousness or uneasiness with others
  • A decline in self-care or personal hygiene
  • Spending a lot more time alone than usual
  • Strong, inappropriate emotions or having no feelings at all

At these parties, I had no doubt illustrated points (3) and (6). The others I also manifested at various different stages in the run-up to my first full-blown psychotic episode. The explosive anger also correlates with the traits of emotionally unstable personality disorder (also known as borderline personality disorder) that I have, specifically, with emotional dysregulation – trouble with managing strong emotions and regulating or controlling these emotions.

The key distinguisher is that, when some of these factors are taken together, they are indicative signs that a psychotic break might be imminent.

Back to the party. I was called a ‘psycho’ (the first and only time someone has said this to my face) by another guest. Now, if I ever met that woman again, I would probably explain to her that this term is loaded with stigma and therefore should be avoided (I’m looking at you, Ava Max). But that’s a gripe for another time.

A Meditation on Recovery

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Recovery, I have found, is quite a lot like Dr Kevin C. Snyder’s conception of success. It does not follow a straight diagonal line upwards to a particular zenith. Rather, the line is wiggly, convoluted, and ties itself up in knots along the way. You may take a fair few steps backwards for every step forward that you take; you may fall flat on your face (several times, and painfully) but the key is to – as clichéd as it sounds – keep getting back up. The scars may still be fresh, and you may well be picking at your scabs long after they have begun to heal. But the fact that those scabs have formed in the first place is the important thing.

My steepest fall on the path to recovery was the relapse in psychotic symptoms that I experienced around six months ago, during England’s first lockdown in response to COVID-19. Due to the fact that I had been ‘well’ for just over two years, my psychiatrist had proposed in April 2020 that I might embark on a trial period without antipsychotic medication. The conversation when this was agreed lasted no more than five minutes over the phone, which I find ridiculous in hindsight for such a momentous decision. Although I was briefly informed of the risk of relapse, the pros and cons of the change to my medication were not fully explained to me. This disastrous decision – combined with upheaval in my personal life and the effect of the pandemic, which was seismically shaking the world through restrictions in every area of life – led to the very outcome I had feared the most: being sectioned for a second time.

I’ll cover sectioning – which is when an individual is compulsorily detained in hospital for treatment under the Mental Health Act 1983 – another time. For now, I am still treading the path to recovery (both in relation to the trauma suffered through the psychotic relapse and my EUPD traits) with all the elegance of a giraffe masquerading as an amateur tightrope-artist. Gingerly, awkwardly and not at all with the poise and perfection that I would have hoped. But recovery is a process. I’ve come to terms with the possibility that it’s not necessarily true that one day I will wake up and think: yes! I’ve fully recovered, I’m cured and everything from here on out is going to be ok. Life is always going to throw crap at you when you least expect it.

But along the way, if you learn to get a bit quicker – a bit better – at putting yourself back together again each time you fall, that’s something to be proud of. And that’s what I’m starting to learn.

THE MIDDLE

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It is conventional to start at the beginning of things, but my mental illness refused to play by the rules, dragging its claws through my mind when I least expected it. Therefore, neither will I.

Psycho. Crazy. Freak. These are the words that I hurled at myself internally when I received my initial diagnosis of an acute and transient psychotic disorder in January 2018. Externally: ‘I’m not mentally ill,’ I fumed. My psychiatrist did not seem the slightest bit surprised by my reaction, and I remember he looked at me kindly. My parents later revealed that he had told them: ‘This is when the hardest work begins for her.’

***

And I thought I knew what it meant to work hard.

June 30th 2017. My graduation. Apprehensively, I stood in First Court of my college as the Praelector (a woman with a drill sergeant’s posture and the exaggerated theatrical intonations of a Punch and Judy puppeteer) ran through the procedures to be followed in the Senate House later that afternoon. Walk up to the Master when your name is called, kneel on the cushion, fold your hands in prayer, listen to a few words in Latin, step back, bow, and walk out. Under no circumstances is anyone in the audience to talk or – God forbid – whoop or cheer. A modest round of applause is all that is permitted. I fiddled with my hood, readjusting the pin that held it securely to my shirt, visions of tripping up on the cushion and crashing headfirst before the Master’s feet to snickers of laughter swirling through my mind.

I barely recognised anyone around me – the product of having holed myself up in my room during Final Year, working feverishly until 2am most nights with the singular aim of getting a First Class Law degree in mind. I had embarked upon a year abroad to France the year before. My few close friends therefore belonged to other colleges and we weren’t able to graduate together. I could have used the reassurance of having my best friend exchanging glances with me or muttering something about the Praelector’s pomposity in French under his breath.

But I felt utterly alone in that courtyard on one of the most important days of my life. I wore a school shirt (for 14-15 year olds) that I had panic-bought from M&S the day before when I realised everyone had left their graduation shopping to the last minute. The oppressive heat, the starchy material of the fabric and the lack of familiarity led to knots of anxiety twinging in my stomach.

Yet – I had made it. At the age of 22, I had fully realised a dream I had previously thought impossible: to graduate from Cambridge with a First Class Law Degree. If success is defined as the achievement of aims, I had no doubt succeeded academically. Moreover, I had emerged from university with strong friendships – albeit with a handful of individuals – but friendships I treasured. I had a long-term boyfriend, snapping photos and smiling at me as he walked alongside our group of graduands completing the fifteen-minute procession to the Senate House. I was extremely fortunate to have a supportive family – Mum, Dad, and my younger brother had completed the one-hour drive from London to Cambridge extra early that morning so as to get the best seats in the house – who I knew were incredibly proud of me. I seemed, on the surface, to have everything.

If you had told me then that fast-forward three short months and I would be sectioned in the mental health unit of a state hospital, hallucinating so feverishly that at times I couldn’t get out of bed, the irony is that I would have called you mad.