Jul 6, 2018
48 hours inside a mental health crisis
It is not a cup of tea and a chat. It is unqualified medical intervention with someone you love, to impossibly high stakes.
I do not want to, in any way, in writing this suggest that people who care for mentally ill people are the ~~~real sufferers~~~ of mental illness. We are not. Although most of us have pretty shoddy mental health issues ourselves, since us mentally ill people tend to look for the same shared experiences as anyone, it’s just instead of “coming from a northern town to dominate the London journalism scene” it’s “now that’s what I call suicidal ideation vol. 33.”
But I do, if not want per se because I would rather I didn’t have to know this but need maybe to write this, because I am a jounalist and reporting on even the deeply personal is a drive. This is a frontline dispatches from the extremely broken mental health services in the UK, from a position of enormous privilege and advantage — this is not that bad.
It is this way because there’s almost no clinical support. And the best-intentioned friends can get it so wrong. And perhaps if people understood just a little bit more, we could get beyond hashtags and saying “you can always chat to me” and recognise that ill people and the people who look after them deserve actual medical care not hamfisted amateur attempts at neurological CPR by loved ones.
It shouldn’t be this way but intimate partners or close friends or housemates are often the frontline staff of mental health services. We’re not trained and we don’t know what we’re doing. We cannot prescribe or refer or initiate services. We can’t write sick notes, we can’t do much to affect a benefits or support eligibility outcome without a diagnosis or frankly even with one.
I’m quite good at it and have the additional advantages of being an adult in my 30s who could just opt out of this but I’m not a magic wand and in many ways this is a story about how that leads to just fucking it up because my best is not an alternative to effective clinical support. How could it be?
Given this is the situation, though, I’d like people to understand it.
72 hours ago (or so) my boyfriend got triggered into a borderline personality disorder episode. It is the sort of thing no one wants to talk about. Here is a timeline.
***
Hour one.
I am recording a podcast, which means I’m slightly at a loss as to what to do when I realise that W has been triggered.
‘Triggering’ gets over-used and misunderstood online. What it means in this context is that something has jabbed a knife into my boyfriend’s mind and violently pried open a barely-controlled world view. When someone goes into this state, it is sudden and extreme — you flip a switch and he goes from a caring, ethical person to a feral animal lashing out, in pain and at total odds to understanding the world.
I can’t describe it from his perspective. But externally, this is what it looks like. It is like he has a splinter in his eye that’s distorting everything, like the boy in the Snow Queen. Or like T’sais in Tales of the Dying Earth, who can’t look at anything without feeling intense disgust. He hates himself most of all — he always hates himself, it’s just that the overall everything is hateful now, so anything liked is despised and anything loathed before is 20 times worse.
It is impossible to challenge this view — or at least I am no good at it — it seems to be settled like a VR helmet that he can’t get off. In that moment, it seems so logical and correct, in a way that energises the episode, that it is as absurd to disagree with it as if I insisted that up was down.
Often the first sign this is happening is lashing out at me. I know what it is and even if maybe it should, it doesn’t damage or especially hurt me — it’s just stressful.
This time he is attacking two of my friends on social media. Over something he knows I feel quite sensitive about and which is, further, entirely abhorrent on his part. To be clear: borderline personality disorder does not specifically make someone do this, it just triggers a hyperaroused state of aggression, vulnerability, fear and self-hate.
Here is ground zero. The next 24 hours are about to get worse.
***
This might sound stupid but I actually don’t take it all that seriously at first. Yes, he’s being horrible and lashing out on social media but I’ve seen him do that before — I know what it is, that someone’s posted about getting better from something, recovering.
For someone who has been in and out of psychological services for 21 years, this is upsetting and frustrating and causes dissonance — something intensely painful for people with unmanaged BPD.
It’s because for all the talking and treatment and trying, for W, it has not got better — it has got worse, he’s got more frightened of himself, he’s lost multiple relationships and burnt bridges and isolated himself because he’s sick and can’t stop. And no one can find a suitable treatment — and every treatment is painful and invasive in its inefficacy, maybe because until recently he hasn’t even had an appropriate diagnosis.
Even when they do find something, it’s going to be a long and grim road out of a short, dank, dark tunnel he has backed himself into. Alone and biting at the hand of anyone who tries to help.
I had terriers growing up, I am not scared of things that bite. It’s probably stupidity rather than nobility.
I briefly have a calm go at him about it and point out I do not like him doing it. This was probably a mistake, as this state likes doing things I don’t.
He wants to do it to reconcile the overwhelming feelings of self-hate he has with being actually hateful. It feels good and soothing. That’s perverse but you see: that is why it is called mental illness not ‘having a mood on.’
I ask my friends to block him and maybe put things too cheerily, that it will be a rough night in our house. I perhaps don’t make it clear enough what is going on. I maybe don’t even clock how bad it is myself because I’m distracted. I should have been clearer — most people do not understand what it is.
By the end of the rough night, I’m furious. Which is the worst way to deal with this. I’m furious because I am a human who loves him not a system of effective psychological treatment and I’m the only fucking thing on shift for this.
I will make it worse because I am the highest end of blundering on this but still essentially on call-up from a five-a-side park kickabout to discover I’ve been drafted into the England team. No one in need of help should have to be faced with such inadequate support.
***
There are lots of fucking useless articles on the internet about how to deal with someone having a borderline episode. The only thing that makes any actual sense and that runs through all of them is: you must stay calm.
No matter how escalated things are getting, you need to stay calm. You need to remain rational. If you have a plan for certain points of escalation, such as calling the ambulance or police service, you need to remember and stick to it. If you have a point where you’d need to remove yourself, you need to do that too.
People will attempt to distract you. The person who you’re trying to look after, other people who are being genuinely concerned but you don’t need to respond to. You have one major thing going on and it’s staying the fuck calm, not rising to the most outrageous bullshit that’s thrown at you.
You don’t have to sit there and take it. You can argue somewhat — although there’s very little point when they’re incapable of seeing anything other than their own worldview. For fuck’s sake don’t agree with them.
Being in a relationship with someone with severe or chronic (or both) mental health issues is not for everyone. You are their partner sometimes, their carer others, except that there is no line there. You have to balance where you exist in that. You have got to stay calm.
That doesn’t mean accepting, that definitely doesn’t mean encouraging. It means being able to maintain your own lines and not respond to provocation (and they will provoke you because they want things to hurt, including themselves) and being able to remain reasonable in the face of paranoia. It’s holding onto your own mind.
It’s not reasonable that you have to. It’s not really humanly possible. But this is the situation you’re put in, where you have to at least try as long as possible.
I don’t say this flippantly but: if you can’t, you can’t do this. That doesn’t make people who can more heroic, it’s just a fact of compatibility.
***
Hour four.
We are arguing on the settee. I have talked him round a bit, perhaps it’s dissipating. He has horrible logic that works only internal to the sort of altered reality the episode has immersed him in, working on a wholly different ethical engine to anything else. I am desperately trying to distract him from continuing being extremely unpleasant online and not really succeeding.
He thinks it’s very important he explains that everyone is wrong and the world is hideous, horrible pain they should be feeling. I am tired of having a circular conversation I can’t win — I am logically nimble and have tried talking him out of these before but he’s having a conversation with a fictional version of me, even if he was inclined to listen.
I ask him for the billionth time to stop abusing my friends online. I probably should have asked once again that they block him and stop giving him a canvas on which to paint this, enabling and escalating a situation only I am physically in because as frustrated as I am becoming with this fact, they don’t understand what’s going on. It will take me another 24 hours to do so and by the time I do I will be so desperate I am becoming frightened myself, something that rarely happens.
But as things stand it is still within standard operating tolerances for an episode. I don’t say that flippantly — it is distressing, of course and hugely disruptive. But this is an unpleasant routine for us.
I start getting messages asking about my welfare and about him. I don’t have the energy for other people’s concern because I am dealing with a very live situation that requires my full attention.
I am used to it so I know it’s an episode, that there’s no point engaging or arguing with him — he’s getting lots of energy from being told to fuck off. Or the episode is, anyway, latching harder onto his brain and giving it infinitely more resources to draw on than I have to remedy it.
Sometimes W can be talked back, like all people with BPD. Sometimes he can’t. There’s a tipping point and we hit it towards 10pm.
***
Night one.
He loathes me — and it’s genuine, in these moments. I have managed to make him go to bed — or he’s chosen to, I have no idea and in the end it’s immaterial.
I sit on the stairs drinking wine because I was slightly too drunk to start dealing with this at the point it began. This is not a good idea but I am also just one woman not a psychological intervention unit.
I am sitting on the stairs because I can hear W snoring. I got out of bed when I was sure he was asleep, having not taken my clothes off to lie down. I am aware there is a small but potentially significant physical risk to myself. I am aware there is a significant and severe risk that he is going to physically harm himself. He has just outlined suicide plans on social media, he is drunk and emotionally belligerent.
I do not want him to die, so I am sitting on the stairs to check he is still breathing. He would have to pass where I am sitting to get rope to hang himself.
By 4am I am too tired to carry on. I get in bed and he hugs me, the way he does when he’s not having an episode and it turns out this is too much for me — in another 24 hours time I will be wondering what would have happened if I had just leaned into it and let it all flow away but I am too angry and probably too drunk and definitely too full of adrenaline. I push him away and get up again for some more sitting on the stairs.
At 6 I end up asleep. I wake up again at 10 and of course he’s already downstairs. I feel an overwhelming sense of failure and I am extremely angry with myself — I’m also physically dogshit and have a migraine. I make a big error.
***
When someone dies from suicide, people get all internet-weepy and say things like ‘why didn’t they reach out’ or ‘you know you can always speak to someone’ or even that you can always speak to them, that their inboxes are open, that they can relate to the desperation.
There’s a sadness around it, that someone who — usually — is admired could have become so isolated, felt that they had no other option.
And when non-celebrities die of it, there’s a bit of sad judgement about their situation — how could anyone have been so cruel to leave them isolated?
I don’t know, in many cases but it’s possible that some people pushed literally everyone away by successfully being a cunt to them. That does not mean they deserved to die or that they did not still deserve treatment and validity and being taken seriously.
But a lot of people do isolate themselves. W is trying to, it’s a pattern of BPD and in particular his symptoms. And he’s been easily horrible enough to do that. He’s become a minor celebrity in our circle of the internet, subtweeted across timelines.
Of course, he’s being horrible. But I feel like my friends have forgotten I live with him and this isn’t an internet joke, this is someone I have to look after. I wish they had blocked him when I asked. I wish this was not being escalated.
Suicide is the single biggest risk to men under 45 in the UK. That’s not because women are less prone to suicidal urges or ideation, it’s because society particularly traps men in not talking about these issues and because men are easier to isolate.
For totally understandable reasons. Violent men, men who verbally or physically abuse people, often do become isolated — especially if they fall into any vulnerable demographics (drug users, LGBT identities, mentally or physical illness, just being fucking poor) and you can see why. You don’t have to tolerate anyone threatening in your life. You do not have to deal with danger just because there is a statistical risk to your aggressor. You shouldn’t.
Despite his worst attempts W is not one of those men. But I do want to talk about those men because when we talk about preventing suicide, about mental health intervention, you need to remember that it might be for horrible people. Who nonetheless, deserve treatment — society deserves for them to receive treatment.
***
Hour sixteen.
I lose my temper totally when I get up the second day. I break the cardinal rule. I have no calmness left. I should have stayed upstairs longer, I should have calmed down but I don’t know if I could have, to come down to realise he is still on this bullshit, still abusing my friends on social media. He thinks it is a game at this point. Maybe. I am not sure what he thinks, so deep in the mirage.
I am uncontrollable by this point, I grab him by the shoulders and shake him. I should not have done this. That is unconscionable. That is the most awful failure of care. I suspect a lot of people who care for mentally ill people have done it but this is where the lack of support is obvious — I’m not sinister or a bad person, I do not want to physically attack W but I am also not a professional, I have nowhere to go home from this, no end to the shift.
The fact it’s understandable (and ‘not that bad’) doesn’t make it any less awful. No mentally ill people should be being abandoned to these risks.
I shout and shout and shout and get him to agree to seven hours where I can work, without him doing this. I am a freelancer and I desperately need to.
I can’t work. I am too furious and now ashamed. I have lost all the calm ability to cope. I feel violently physically ill, barely able to breathe and I have fixed nothing. The ceasefire won, I end up sleeping on the sofa because I cannot do anything else. At this point, I am miserable and exhausted and broken.
He’s had a good night’s sleep and is feeling buoyed up on whatever adrenal or endorphic rush acting out is giving him.
My inboxes, all my inboxes, are full of concerned people offering the eternal “any time for a chat” or any other fucking platitude. I do not want a chat. I do not want to go anywhere. I want some sort of energy power up.
In lieu of that, I take the seven hours. I am not stupid enough to think this is over but I hope perhaps it will sputter out a little, cut off from its supply.
***
If my boyfriend came back from hospital with a physical illness, after being told there was no more treatment that could be tried and he smashed up the entire house in a rage of frustration that would be a great, cinematic outpouring of emotion.
If my boyfriend did that if he was told there were no other mental health options left to try then he would be sectioned.
Mental illness is not just the mental illness itself, it is the emotions around the mental illness. Some of which become comorbid conditions — you can most definitely be depressed about being mentally ill.
We know that chronic conditions of any kind have emotional effects on people. Living long-term with any kind of condition, especially if it has limiting aspects, is something that endless research has proved creates its own mental health challenges even when it is well-managed. Some of these have physical consequences, from deteriorating condition management to basic lack of self-care, etc.
Mental illness is viewed as dangerous to have feelings about. You’re supposed to mindfully wipe away your emotions about your own condition and any outbursts you have about it are classified as part of the condition itself rather than an additional reaction, one it might well be perfectly healthy and reasonable to have.
W is the least physically destructive person I know and has certainly never smashed anything up but these are the parallels you have to consider in the physical/mental health socio-cultural gulf.
***
Hour twenty three.
Someone has messaged me “oh fuck here’s round two.” I don’t think they are thinking about the fact this is not on an app for me. I cannot turn it off. Round one has not ended, in our lounge.
It’s not reasonable for me to be expecting them to be thinking about that when they are dealing with entirely different things. But here I am.
Everyone else is asking me to find a way to make it stop when they could just use the block button. I cannot block my house. It’s unreasonable but I’m getting extremely angry with them because even though no one is spurring this on but him, I wish everyone sending me messages of concern would also stop (unknowingly) helping him.
This is the isolatory bit, even for me with a big network of friends. I am alone in this and no one is going to join me. My friends, to be fair, are being enormously patient with the horrible stuff W is sending them and it probably seems unfair that I wish they were not.
I start the process of begging my friends to block him. In the end, I ask publicly. It stops it. In that sense.
***
Why would I stay with this dude? W asks me, often. When he’s having an episode it’s more paranoid. It’s always disbelieving. He told me he was a piece of work before we got together. Well, so am I and maybe that’s why I can deal with it in the balance of the good times.
The bad times are bad. They’re terrible. I’m calm until it breaks down into hysterical tears because I am not the entire clinical psychology profession and although I’ve done mildly better than some of their attempts, I also have no backup from them.
W finished one course of therapy recently. It was a disastrous course that set him back miles, with a premise set to fail. We are waiting and waiting for anything more — even the assessment that could lead to it.
In the meantime, unless I section him, there is nothing I can do. I do not want to section him — sectioning is an emotionally and physically violent process where you take away someone’s right to freedom about any of their choices. I do not want to do that unless it was the last of all possible resorts — there’s also a very appropriately high barrier to sectioning someone, so unless there is a strong physical harm risk it’s not an option.
It’s probably a character flaw of mine that I am relentless and will not give up. Or maybe it’s my own well documented mental health shit. I do not in any way know what a half measure is. It’s certainly going to kill me one day. But as someone who watches people drive cars, top speed, at concrete walls for a living I cannot pretend that I am not comfortable with staggering risks.
That said, I am not here because of some sense of obligation nor as a sacrifice, I am here because although my boyfriend has staggering episodes of awfulness, he also makes me very happy. I fancy the pants off him and we have lovely times together, he’s one of a handful of people I like cooking with or just sitting and watching telly with. He has made me feel at home in our house in a way I hadn’t realised I had not felt for a very, very long time. He puts up with my shit and we laugh a lot together.
We have a very healthy and equal relationship when this shit is not going down. Some people (most notably children who care for their parent/guardian) are forced to stay with someone they look after but I am very much not.
I can also reconcile that he has done something awful with still loving him. It’s not excusing or even forgiveness. It’s the complexity of the ins and outs of the fact two mentally ill people in a relationship is not simple or straightforward.
After the episode, my social media inboxes receive a steady trickle of people I have never spoken to in my life saying I don’t know my own mind, that I need to be rescued from this situation, some hilariously patronising things about whether I or W have “spoken to a GP” and 60 other things that sweetly suggest they know me and my household and my relationship so much better than my daft little head could ever. I had in no way asked for advice. Don’t fucking do this.
***
Night two.
I have reached one of my points where I have determined I should remove myself from the situation. I get through the front door and sit on the garden step.
I have a choice, here. There’s a risk that has now become significant it might be dangerous for me to be in the house. I am also aware that the episode, with W’s words, has just crowed on Twitter that it’s finally alone.
I contemplate how stupid or maybe brave I am. It would not be unreasonable to walk away right now, no one would blame me — people would call me insane for going back through the door.
Obviously, I do. That isn’t a moral statement, it’s just a reported fact. I decide I’m not finished here — and only I get to decide that.
I ask him to come to A&E and I’m surprised by the fact he comes with me. it’s worse than useless in that we wait hours for him to lie to some doctors. We go home.
Maybe it’s not worse than useless because we have a conversation about nothing, it derails the dissonance, it’s maybe the final push back towards normal. By the time we get in bed he’s barely hostile.
***
W is a small man. I am a very large woman who knows how to fight. It has never occurred to me to consider him a physical threat.
This seems to be the way with any couples who can get through the unmanaged stage of this. I don’t know how I would find it if that was something I had in my mind. Certainly, different. Probably intolerable.
***
Hour fifty two.
By ‘barely hostile’ I mean we are having a dialogue about why I hate him. This is circular, in that he wants me to hate him and is also deeply wounded by the idea I do.
He says I must hate him because I asked my friends to block him. I have cut him off from things. I understand why this logic works.
I don’t say it’s for his own good because that would be dishonest. At this point, it is entirely for mine.
***
I wish I had not had to ask. I wish none of this had happened. I wish I had magic powers to fix it.
People will tell me I did good, days later. I did not. I did… passable, at best. Nothing good came of this, only bad limitation. And to be honest, very little of that.
***
Hour sixty-something.
We talk on the sofa again and he admits he’s scared. It is over, except for all the sorting through debris and the conversations we’re going to have to have in addition. And the rest of our lives.
***
I know we’re not being invited to things because of the perceived risk of something like this happening. Mostly because people apologise to me about it. I don’t think they apologise to W — and well, I doubt many of my friends are going to speak to him after this one.
But people are so scared of this that my woke friends who talk openly about mental health won’t be in the same space as it.
That’s understandable. There are different dynamics between them and W and him and I and I wouldn’t be blamed — and shouldn’t be — for noping out of this situation.
Someone suggested the calm I feel during these moments is dissociation and maybe it is but I don’t think so; I am a pragmatist, emotionally and generally and have a lifetime of experience dealing with mental illness in my immediacy. I am pretty good at non-judgement at the time of the episode, where the practical concern is to de-escalate and stop it. Talking comes later. It doesn’t scare me, it’s just sad and frustrating.
No one would be wrong to be scared.
He’s actually very unlikely to do anything in person because he’s at best shy. These episodes are cooked up in isolatory solitude. I sort of knew we were due one — I’m not entirely sure how but like a captain knows the seas, some slight changes or withdrawals or little tells had tipped me off that he was teetering. I wish he had better ways of managing it when he is. He does not want these episodes, even if there’s a weird, perverse brain pleasure to them in the moment.
I’ve had several cancer scares in the last few years, one rather beyond scare. Bits of my organs really super want to make tumors and although it would also create massive problems, those tumors will be having a fucking time absolutely consuming the rest of me. Morally, no one will judge me if or when they get me and no one will suggest it could be helped with a chat rather than a clinical intervention.
I don’t blame people who don’t put up with this shit. You are not wrong for not accepting these unpaid and unofficial medical positions by default of proximity, you’re certainly not wrong to refuse to deal with it, it is extraordinarily unfair that society pushes people to be asked to.
I don’t think people think this should be the way it is. But I don’t think people realise how incredibly difficult it is for it not to be — the vast, colossal gulf between the current situation and a functional mental healthcare system is so massive it’s a Marianas Trench of funding shortfall, lack of infrastructure, lack of trained professionals, lack of anything other than amateurs trying and failing their best and of terrible, terrible risk to mental health patients.
