In a dramatic departure from my initial idea for blogging, I decided that I should write about my own mental health experiences, at least in some posts.
Rather than writing my own history in one post, I’ll just offer pieces as they are relevant.
I’m 37 years old, and I have recently discovered ADHD. This year has been the most difficult in my life. I’ve fought the National Health Service (aka the NHS – I live in the UK) and the private health sector that plugs some of the NHS’s gaps a a like a tea strainer over a gushing downpipe. I’m exhausted by the process. It isn’t over yet.
I’m trying to wean myself off Sertraline, which I was offered after a misdiagnosis for Generalised Anxiety Disorder. This is a common misattribution of symptoms for many with ADHD.
Today I don’t feel that great. Sometime I know as soon as I wake up that my mood is trending negative and sometimes ADHD’s propensity to flatten emotions towards a dull median masks what’s underneath until I open my mouth. The act of speaking reveals the feeling. Someone is communicating for me, or maybe I for them. I’ll usually follow that emotional arc through the day.
The issue is that Sertraline and other medications that can be used as anti-depressants also flatten emotions.
So is this flatness “me”. What does me even mean here; is it just a tribute distinction between “my chemicals”; ie the ones my body produced or the exogenous drugs? Does that even mean anything? If I take other chemicals to alleviate this, does that mean that the “me” when the chemicals are high is the real me?
I often think of the film sleepers with Robert DeNiro. I saw it 20 odd years ago. In my memory of it some victims of the Spanish Flu in 1918 are still comatose years later as a result of the virus but are re-animated by a new drug. They develop a tolerance, their moods change and then they slip back behind glazed expressions and silent lips. I worry that my ADHD meds won’t work forever and that I will slip back too. I’ve never known a fear like this before.
Anyway, back to flattened emotions. What doesn’t help is that having low emotional valence means that I have a poor vocabulary for describing how I feel. It is almost as if the emotions exist on the surface of a pond; I can see only what reaches the surface – not what produced the effect. So I’ll say “good” or “bad” or, on a particularly insightful day, “happy” “angry” or “sad”. But I don’t know why. That makes it hard to know if it is less sertraline exacerbating an emotion I’m having because of a life event (I have a long-term back injury that prevents me from riding my bike which is my main therapy and it was particularly frustrating yesterday) or whether it is a conjured mirage purely created by a chemical imbalance. In my mental head it matters profoundly; in my biological head it matters little.
My emotions move a lot within a middle range and then snap to 9/10 or 2 – they never really hover relaxingly in the 4-7 range. Even when they are at the extremes, I can’t define them. They are nebulous and cruel or euphoric and vaporous. I can’t pin them down or even squint enough to describe them. When they are in the middle a gaseous analogy works just fine. But when that cloud is suddenly ensouled by a angry grump or an unexpected optimist, definition might help me understand exactly what is making me that grump.
So, today hasn’t started well but then that drove me to scribble this down, and I feel slightly better for it. I’m at the end of a week on a specific dose of Sertraline. I’m reducing it by degrees (5mg a week) because any faster brings on a depressing numbness (I’m not calling it depression). Until yesterday that seemed slow enough.
Of course all this can affect work and is hugely exacerbated by the issues with the health system in the UK. The US system has been brought into sharp relief by the murder of the United Health CEO. In my experience the system here in the UK has other issues. When you are in acute difficulty (you have a heart attack, cancer, or other physical ailment) the system functions. Mental health is a different matter.
For ADHD the process seems designed to frustrate – and frustrate efforts to get help. For access it requires the completion of arcane admin tasks that seem tailored to impede a person with ADHD, a convoluted set of thoroughly inadequate or inaccessible options, and – if you have the money to pay for the privilege – the necessity of mediating between public and private systems of diagnosis and treatment that share a deeply petty mutual antipathy.
The analogy that occurred to me is one in which a person with a broken leg is told they can be treated – if they can manage to walk to the hospital carrying a heavy sack of gold to pay off a few toll booths on the way.
Or they can wait eight years for a bus.