By Dr David Laing Dawson
Some years ago, having published my fourth novel, I was asked by a local writers group to be guest speaker at their monthly meeting. I accepted, and when the date arrived I found a group of about twelve people sitting around a large table. The first half of the session went as expected as I discussed my approach to writing, and novel writing in particular, and they joined in, asking questions, sharing thoughts. Then we broke for coffee. A few left immediately to fill their cups but the majority remained with me at the table. They knew of my other profession and started asking me questions about mood stabilizers and anti-depressants, and sharing their own experiences with these medications. And suddenly, rather than being speaker at a writers’ meeting, I became a psychiatrist in a Mood Disorders Support Group.
It is not all that surprising, I think, that bipolar disorder is over-represented among writers, and that within this demographic it has been estimated that half of all poets might be so afflicted.
It has been said as well that depression fuels the furnace of creativity, providing the writer with anguish, with despair, with glimpses of hopelessness, and a wealth of existential questions, while mania, or at least hypomania, provides both the energy and the optimism to put pen to paper, or fingers to keyboard.
And for a psychiatrist, or anyone else who likes stories, bipolar disorder, among the mental illnesses, provides the best, though not always with happy endings. Here are a few:
In the winter of 1968 a tall man was brought to the emergency of a big city hospital. In my memory he towers over me though that may have been his mania rather than his height. I was an intern that year, and this man who would become my patient for a few hours, was the chief librarian of a major institution and held PhDs in English and Library Science. And he was indeed manic. His eyes were alight as they always are in a state of mania, seeming to see in more dimensions than I. Of course he could not stop moving or talking and so I walked beside him and listened as we made the full U shaped journey through the Emergency Ward several times that evening.
He had a revelation to share and this revelation was literary for within his excited stream of consciousness he sprinkled a hodge podge of quotes from poems and literature spanning more than a few centuries. He spoke too quickly and with an excess of erudition for me to follow and at the time I wished I had a tape recorder for his revelation may have been significant, but surely forgotten by tomorrow.
Now and again he paused in his stride, not so much to catch his breath as to see if his amanuensis was keeping up. And each time he paused I would reach into my white jacket and offer him a small tablet of chlorpromazine with a Dixie cup of water and most times he would take it before he was off in full flight again.
Eventually he slowed, both in movement and in speech, and eventually he sat. And then I was able to convince him to walk with me across the hospital and up an elevator to be admitted to the psychiatry ward. This he did, quietly now, a little wary and vigilant, and I handed him over to a nurse and wrote the admission orders.
I don’t know what became of this man of letters but I hope he stayed on his lithium and I hope any future bouts of depression or mania did no irreparable damage.
I had treated this young man in the big mental hospital outside Vancouver B.C. though he was from an Alberta ranch and wore the requisite Stetson and boots. He had driven straight through the Rockies and the Fraser Valley without stopping on his way to Vancouver. He managed this he said by holding his foot to the pedal while pissing in a bottle and dumping it out the window. He repeated this. “Piss in a bottle, dump it out the window. Whooee.”
I don’t remember what had attracted him to Vancouver in the first place; the rumoured nude beach? The hippie scene on Fourth Avenue? But I do know that at some point the Vancouver City Police found him encamped on the roof of their headquarters unfurling a banner over the side.
He didn’t think much of taking medication and he thought even less of the nurses telling him to stay away from the vulnerable female patients, but eventually we got him settled enough to send him home to Alberta and the family ranch.
A year went by and I was now working at the brand spanking new psychiatric hospital on the UBC campus in Vancouver. These were very optimistic days in psychiatry with both new and effective medications plus the idealism of the sixties. This unit, which would eventually become part of a neuroscience section and one program in a Health Sciences Center, had no locked doors, beyond the pharmacy. Earth toned colour scheme, carpeted floors, single rooms, wide short corridors, teak furniture, comfortable beds, nurses in civilian clothing, Docs shedding their white coats, all patients voluntary, community meetings every morning, even a fireplace in the lounge area, and a very nice, well appointed auditorium on the main floor.
There’s a call from Alberta they told me. “Will you accept the charges?”
It was the young man I had treated a year before. He had stayed on the family ranch for a while, attended a clinic in Lethbridge, but now he was off his meds and his father had sent him as a buyer to a cattle auction in Calgary, with money in his pocket. But some guys were looking at him, and talking about him, and calling him “queer and shit like that”, and he was getting paranoid. He couldn’t stay at the auction but he was supposed to stay and to bid on some good breeders, he said.
I spoke with him for awhile ignoring the long distance charges. I’m sure I asked him to go back on his meds and/or take himself to the nearest hospital emergency. I do remember feeling some relief after he hung up, knowing that he was currently in Alberta and 600 miles away from being my responsibility.
My day passed uneventfully, with patient meetings, conferences, team meetings, until mid afternoon when the front desk receptionist at the main entrance paged me to tell me that “Your patient is here asking for you. He’s wearing a cowboy hat.”
And there he was, as big as life, as loud as life. He had used the cash in his pocket not to buy a heifer but a one way plane ticket from Calgary to Vancouver. And I calculated in my mind, belatedly, that 600 miles is not a long distance when you are manic, impulsive and have some cash in your pocket.
He didn’t want to come up to my office. He needed open space, he said. No walls, man, no walls.
That well appointed auditorium was behind the main reception desk so I took him there. He chose a theater chair in the very middle beneath the high ceiling and I sat beside him. He was okay with the space of the auditorium though it wasn’t t like the open prairies of Alberta where he could see forever and didn’t have to watch his back.
Once more he became my patient and again I took on the task of getting him on and keeping him on the right medication. One day, as an outpatient, he expressed his disdain for medication quite dramatically. In my office he took a vial of pills from his pocket and placed it on a solid wood coffee table. Then he drew a hunting knife from his other pocket and said, while repeatedly stabbing at the now scattered pills and the table, “This is what I think of your God damn pills.”
“I hear you, I hear you.” I said.
But eventually, again, he became well enough to long for the open sky. His parents sent money and he flew home to the family ranch near Lethbridge.
Five years ago the secretary/receptionist for the mental health clinic of a town 100 miles from Toronto came to interrupt me in my office. “There’s a call from Toronto,” she said. “A Doctor Philpott. He insists on talking with you and he says it’s urgent. Do you want me to put it through?”
“I don’t know any Dr. Philpotts, but sure, why not.”
When I picked up, the voice on the phone said, “Hi, Dr. D. It’s Frank Rivers. Remember me?”
Twelve years before this, when in his late teens, Frank had become my patient after admission to hospital in an acute manic episode. And for the following 6 years he took his lithium diligently and remained well and successful. But neither Frank nor I were ever sure this episode had not been a one-off, a manic episode fueled by, or triggered by, some party drugs he had used. So we discussed the pros and cons, the risks associated with staying on the lithium indefinitely and the risks of going off it. He opted to stop the lithium and soon I lost him as a patient.
I know in the ensuing years he became a star salesman for a major telecommunications company, his hypomania being a source of his success, and he was sometimes in trouble. But because he was now an adult he was not referred back to me.
And now, that is five years ago, he was calling from the Sutton Place, a not inexpensive hotel in Toronto. He had eloped from Toronto’s CAMH Mood Disorders Program and booked into a Penthouse Suite. His employer had put him on sick leave and he wanted to come back to see me. Would I take him on again?
Of course I did, and he has been stable now for these five years, and we have had the time and space to discuss all the problems, and the nuances of having bipolar disorder. On the edge of mania he has the gift of reading people and persuading them to buy, to sell, to make a deal. When a little depressed he feels guilty about this. When thinking clearly and calmly he is embarrassed by some of his antics when manic, and then anxious about meeting colleagues who have encountered him in that state. And stigma is a constant worry for him. Should he hide his illness or wear it like a prize?
He is aware of the harm, embarrassment he has caused others when manic, and he suffers some symptoms of PTSD from his hospital admissions, which sometimes included seclusion rooms and forced injections. How much of his current lack of ambition is his fear of relapse, he wonders. And we discuss all the stresses and situations that might put him at risk: Parties? Travel? Late nights? Drinking? Affairs? The corporate life? And for him, what are the warning signs, and can he recognize them when he is having a good time? We talk of the necessity of sleep, exercise, routine, and solid relationships, to maintain a stable mood.
And we have also talked about the benefits of being bipolar: the bouts of high energy and accomplishment, fearlessness, creativity, and persuasive powers.
Today he takes his medication religiously and he seeks, as I suppose we all must, the right balance in his life, which means to some extent, knowing when to avoid the party and when to leave the party, go home, take your medications and go to bed.