I tell myself it’s like being California. Being relaxed sunny California hit by an earthquake. There’s little or no warning. The subterranean shift is catastrophic. There is shaking and destruction for an initial few hours; then a brief pause in which I hope it is over. There are the aftershocks that come in waves, but which slowly settle to mere wobbles. Eventually the rubble is still, help has arrived, and the wearying, depressing, hopeful rebuilding can begin.
Somehow an external metaphor helps.
Last week was a really good one. One of the best in my seven years post-breakdown. All was going well: work, relationships, energy levels, happiness, writing.
Then suddenly it wasn’t.
On Monday morning I was crying and didn’t know why. (That can happen, so I wasn’t particularly worried. My primary diagnosis is depression after all.) I went to my therapy appointment as normal, walked into the waiting room at five to two, sat down. By two when the appointment was due to start I couldn’t move, speak or open my eyes. I was lolling in the chair, unresponsive. No drugs were involved, no alcohol. Merely my nervous system exploding into shutdown in the way that it sometimes does.
It’s called dissociation. It’s an extreme of the fight/flight/freeze response, a learned reaction to trauma. Something had triggered it. I still don’t know what.
My therapist is skilled. He’s got me out of these states many times in the past. He knows that strong smells and movement can help to switch my brain back on. He wafted lemon oil under my nose. He got me standing, walked me up and down the corridor. I was shaking violently, kept collapsing into the walls and onto the floor. He moved me very slowly, holding a lot of my weight, guiding me because I couldn’t open my eyes.
It didn’t work. This time I had gone too deep. And so, after a while, he did what you do when someone is unresponsive: he called an ambulance.
It’s a problem when you can’t respond to paramedics and your arms and body when lifted up drop heavily back to the floor. They work out quickly it’s not a cardiac arrest because they can feel a pulse. Then their voices slow down. Next come pain tests to check the level of physical arousal. I twitched a bit in response to the most painful of those.
It’s a strange state to be in. There’s a small faint part of my cognitive brain that stays online, so I mostly can remember a bit of what happens. I’m vaguely aware of it at the time as well, but I can’t control the physical reactions. Over the years I have got better at that: I’ve learned to keep breathing to calm the parasympathetic system down. But this time that didn’t work either.
Eventually they half-carried me into the ambulance and there the paramedics talked kindly to me for, I believe, quite some time; maybe an hour, maybe more. By now I was periodically waking up into violent shaking with bits of screaming, before collapsing again into complete unresponsiveness. In the end they took me to A&E.
There followed more of the same, exacerbated by hours of tests, bright lights, constant loud noise. ‘Try to relax,’ they said, as the rounds of uncontrollable shaking came again and again, and as, hour by hour, my time there was extended because there was an anomaly in a blood test that suggested I was having a heart attack, and because I was so confused and shaky I couldn’t say clearly what had actually happened in a way they could understand.
It took twenty-four hours in A&E, two rounds of blood tests, two ECGs, a heart scan, a chest X-ray and the opinions of two consultant cardiologists before the heart attack was finally ruled out and I was discharged to the psychiatric hospital where they know me.
There I saw my usual doctor who has seen me go through this tens of times before, who is concerned when this happens but not alarmed. By now I was only shaking periodically. Mostly I knew where I was. So long as I held the walls I could walk. My doctor asked me to stay in for a night, as I knew she would. I did that, and then refused to stay a second night, as she knew I would.
That was Wednesday. Today is Friday. Today it is sunny outside.
And so, California. The rubble has stopped moving. It’s time to rebuild. As always when this happens I am deeply confused, betrayed by the sheer unpredictability of my own brain. My confidence is shattered yet again.
But where five years ago earthquakes on this scale were frequent, now they are unusual. At the same time the spaces in between are much better. A lot of the time now, diagnosis of depression aside, I am not just dragging myself through life.
It’s hard to think of this progress in terms of years. That hurts. But if I get past that and accept that’s the way it is, then there’s clear improvement. Year on year.