Sleepless highs – Part 1

This story documents about eight days in November 2014, where I experienced my first true episode of mania. Due to the level of detail I go into, I felt it necessary to break it up into two blogs. This is the first one.

Things went pretty well after that. I attended my cousin’s wedding, I reconnected with Uni friends, and went on a road trip to Berlin to watch the world cup final. I started back at University in September, moving into a new house and ended up finding a girlfriend. Things were certainly looking up for me. I was also playing a lot of rugby this term, getting picked regularly for the first team and consistently playing well. The course was fun, and I found time to balance work with going to the gym, as well as seeing my friends and girlfriend. Again, like with what happened in 2012, I put this brief encounter with darkness at the start of Summer right to the back of my mind. I didn’t really discuss the events with anyone, and if I did, it was with very little detail.

It was what happened in a particular week in November of my second year, in 2014, that affects the way I live to this very day. It was at this point in my life where I first made contact with a mental health crisis team.

Throughout the course, we get to choose, or are assigned extra projects to take on for a week, to up to eight weeks, depending on what year you’re in. My project in second year involved a week of research as well as a 1000 word write up. This seemed like a fair task at first, as I had a full free week to start my reading, to plan the essay and to write it up, fully referenced.

Things did not go to plan.

For some reason I felt more happy than usual. My thoughts seemed clearer and I became more chatty with people. I got easily distracted and lost focus on the task at hand. My thoughts, slowly but surely, starting getting quicker, and it became difficult to process one simple task without thinking about fifty other ones at the same time. My sleep was steadily deteriorating, but I felt rejuvenated when I woke up.

On the Wednesday of that week I got very little work done, to the point where all I had come up with was a title for the essay. Afternoons, of course are dedicated to sports, and I had been picked for the first team. Brilliant. What’s more was that my mum had planned to visit me for the day, and had come to watch the match. This was a rarity as she very much hated, and still does, hate seeing her ‘boys getting hurt’. I remember being very aggressive and very vocal during the match . I was excited, not only because we were winning the match, but also because I hadn’t seen my mum in two months. I was also excited to break the news to my mum that I had a girlfriend.

In the evening, we went for a meal in town. I remember on the way in feeling a great deal of empathy with my mum. I was listening to her issues with having to put up with my dad and younger brother’s boisterous behaviour at home, and comparing it with my own attitude to some of my housemates’ behaviours. I felt like I was the mum in a house of guys. I had hadn’t been able to do this so easily in the past. To be able to relate to someone on such a level, almost to the point where thought I knew what they were thinking and feeling. The meal was lovely, and our mother-son catch up felt nice and accomplished. Later that evening I attended the annual rugby bonfire social. I drank a lot of alcohol. However, I felt incredible, and I felt confident, strong and unstoppable. I was what people would describe in the social context, as ‘on form’.

Getting out of bed the next day was not an issue for me. I was a little tired, a little parched, but I didn’t have a headache. Slowly but surely my thoughts returned to the pace they had been previously in the week, if not slightly quicker. I assumed that this was a straightforward reaction to the stress of working under pressure with an essay due in Friday. I waltzed to the library with a big grin on my face. “I beat the hangover!”, I thought. I spent the whole day focusing on my essay; writing, reading and analysing each specific research point and putting it in the context of my essay’s agenda. I only went home to eat dinner and rest for an hour or so, and then back to the library I went.

That evening my brain was firing on all cylinders. The only diversion from my stress was the pure relaxing tones of my iPod’s ‘chilled playlist’, consisting of artists such as Simon and Garfunkel, Tracey Chapman and Fleet Foxes.

“Oh my God. I’ve got it!”, I thought. “I’ve actually got it!”. I’d had an epiphany.

Having just recently finished a couple of weeks of lectures on Virology and Immunology, I was completing a a respective feedback form, and I had thought of a way that could potentially better improve the teaching. It was to do with incorporating physical 3D models of viruses, antibodies and their respective receptors to help tactile learners better understand the ways in which our immunity works. I immediately emailed the two Doctors who delivered the lectures, with my ‘bright idea’. I didn’t stop there. I emailed my parents, my project tutor for that week, and the director of years 1 and 2, insisting that they heard about my idea that would ‘change the way immunity would be taught forever in medicine’. Retrospectively, I was completely manic. Looking back at the emails I sent in early November 2014, they were quite eloquently written, however very excitable and aggressive. I genuinely believed that if I somehow failed at medicine, I could pursue this idea as a business model and make millions from it. I was deluded. I also believed that my intellect at this point in time was similar to that of Einstein, Shakespeare and Mozart. These were delusions of grandeur. I was not well.

Confusion in Paradise

This time I was 20. Having just finished the first year of my medical degree, I flew out to Greece to work as a hotel receptionist for eight weeks. Sun, sea and plenty of sailing seemed like the ideal working conditions for the Summer. What could be better, right? Everyone was so friendly and inviting. “You’re the new guy, right? Come join us for a beer later.” And “Hey, how about a quick ski tow before work tomorrow?” etc. It all seemed perfect. I was enjoying the work, enjoying the guests, and enjoying my relaxing time off even more.

I became stressed. The workload started to take its toll on me, and the pressures of not making a mistake in the first week felt very apparent. One of my colleagues had received a disciplinary that week following an investigation into her performance, and had found she had made several crucial errors over the course of her time there. I guess the stress helped at first. I had so much adrenaline that I could power through shifts with ease. I could maintain a friendly face with all the guests and co-workers. But then I started to lose sleep. I’d start to worry about the prospect of receiving a disciplinary. I would wake up at 5am, again and again, night after night until the Sunday of my first week, where I had to work the night shift on front desk. I was required to stay up all night, until 8am the next day until handover, performing several mundane and monotonous administrative tasks.

The following day, my day off, I went to the beach with a few friends I had made from work and, again, this time on my own, I broke down in tears for reasons I couldn’t quite make sense of. Why was I crying when everything around me was so brilliant? In theory, I was having a ball! I was doing a job I enjoyed, surrounded by beautiful scenery and incredibly friendly people. I had received mentions of written gratitude from guests the week earlier. I had helped make their holiday fantastic and everyone thought I was doing a great job. So why on earth couldn’t I stay happy and positive? The next day I started to become fixated on people’s conversations. I was obsessively paying close attention to each and every word that was being said. I thought people were talking about me, but not to me. I could hear what they were saying, but I couldn’t interpret it as normal conversation. It seemed loaded with secret, hidden messages that were trying to tell me to quit, to give up and to pack up and go home, because they didn’t want me to be there. This scared me, and slowly but surely I became very delusional. This time, however, I was not taking Lariam. This time there didn’t seem to be a single, direct cause to my odd thoughts, my lack of sleep, and eventually, to my low mood.

Me: “I need to come home, mum. They’re all talking about me. They don’t want me to be here.”

Mum: “Who’s talking about you, love? What do you mean they don’t want you there? You’ve just started and you told me last week that they love having you!”

Me: “No. You don’t understand. They’re sending me messages and I’ve done lots of bad things, so I need to come home.”

I was beyond reasoning with. I was irrational. Ultimately I was psychotic. This was serious. I started to believe that the food I was being fed was poisoned. I was refusing to leave my accommodation. I thought that people were spying on me from a van outside, and that the TV show my roommates were watching had hidden secret messages in them. I firmly believed that they were telling me a story about myself, and this belief was impossible to shake. I began obsessing over the smallest of details, and would take much longer than usual to perform the most basic of tasks. I neglected all of my basic bodily needs. I was petrified. My manager came to see me towards the end of the second week, and could clearly tell that something wasn’t right. He would ask me a question, and I could barely answer in coherent sentences. I fixated on what he was saying, pulling out specific words that would form a connection in my mind and would translate as a secret message. Imagine that someone was speaking to you in a language you couldn’t understand, like Japanese. They would then throw in an English word here and there so you could understand some of what they were saying, but it obviously wouldn’t elicit a sensical response from me. I guess it was kind of like that for me with every interaction.

Following a discussion between my manager and my parents, I was put on a flight home. I was informally assessed by a Psychiatrist and a GP who we knew through friends. They believed what had happened was called ‘an acute stress reaction’. No official diagnosis was reached. I was given a single dose of Valium (Diazepam) on arrival home. This helped settle my thoughts and allowed me to remain calm. Most importantly, it helped me sleep. My regular mood and sleep pattern soon returned to its usual state. I quickly recovered, and was able to go about my daily life relatively care free.

Enjoying a day trip away from work.

The Delusional Drug

Me: “They’re sending me messages, Mum. I swear, they’re sending me messages.”

Mum: “Who are sending you messages? What do you mean?”

Me: “I don’t know who, but I just know that they’re sending me messages.”

I was petrified, confused and exhausted.

I had just turned 19 when I first noticed something wasn’t right. It didn’t seem tangible. It wasn’t like anything I had ever experienced before. My brain was completely muddled and I felt like I was at a loose end. It was December 2012, and I was preparing to travel and volunteer for five months in Tanzania, East Africa. I had just started taking one of the more controversial, but very effective anti-malarials – Mefloquine, also known as Lariam. My Mum was cautious to start me on this medication due to the adverse effects my Dad and brother had experienced in the past. However, because it was taken on a weekly basis, it seemed the most logical choice.

I was experiencing symptoms for roughly two weeks before any of us realised that it might be the drug I was taking that was responsible. I started to make unusual connections that would be regarded by a healthy brain as nothing other than very tenuous. I started to believe that my girlfriend’s family were sending me messages through brochures they were leaving at my house. Because of these ‘messages’, I believed that I was a bad person. I was waking up at 4 or 5am, wide awake, with a strong urge to get out of bed and keep packing my bags for travelling. I developed a fixation on this. 

I soon became very low in mood and I vividly remember breaking down in tears in front of my whole family at the dinner table. I was unable to articulate what was causing me so much upset. It was rare for me to cry. I was a rugby player. I was a man. It wasn’t natural for me to show so much emotion, or so I thought. 

Lariam is an antimalarial that is commonly used in the US and British Armies, and it was recently found that many troops had reported adverse side-effects, such as depression and psychosis. These are now well known side-effects of the drug. However, there was no strong family history of depression, and certainly not psychosis on either my mother or father’s side of the family. It was only when I started showing symptoms of paranoia that my mum told me to stop taking the medication immediately.

Soon after I stopped taking the Lariam and switched to an alternative – Doxycycline, my symptoms resolved. My mood returned to normal. My thoughts became clearer. I started to sleep much better. This brief encounter with darkness was over, for now. I flew out to Tanzania to teach English and help on a building project. It was incredible, and forgive the cliché, but I felt enriched from the experience. I came back happier than ever, feeling more independent and mature. I put my moment with darkness to the very back of my mind. It didn’t seem necessary to even comprehend what had happened. It was the drug, that was all. Why should I be concerned about it ever happening again? And then it happened again.

Awaiting my flight to Tanzania