Monday 29 December 2014

My way out of the dark wood

In the mid-eighties Eoghan Harris suffered a panic attack which heralded a battle against manic-depression. Here he tells how he won that battle and tackled the silence surrounding mental illness

Published 06/10/2013 | 05:00

GOOD MENTAL HEALTH: Eoghan Harris suggests taking up swimming and going for walks with the dog, along with meditation or a calming pastime such as fishing or knitting, and the avoidance of deadline disasters by doing work in advance. Photo: Tony Gavin

'IN the middle of my life I went into a dark wood," says Dante in the Inferno. Early middle age is when we mostly experience what was once called a nervous breakdown. What follows is a flat account of my own experience. It has a happy ending – I have not had a bad depression for the past 20 years – but it came after considerable effort.

In 1984 I was writing plays but drinking heavily. One day, buying a tie in Michael Barrie's of Duke Street, I suffered what I thought was a heart attack. It turned out to be a bad panic attack, the first of many.

Because I was writing a play about West Cork Methodists I picked up the name of Professor Norman Moore of TCD, a Methodist, a professor of psychiatry, and a man both old and wise. Both his diagnosis and prognosis proved to be correct in every detail.

Moore believed I was using alcohol as a drug to mask a bipolar condition. I would first have to give up drink, and then wait for the real problem to show its face. So I engaged the will and went cold turkey.

The year that followed, 1985, was one of the most productive in my life. I finished a major play, Souper Sullivan, that would eventually be produced at the Abbey. But the darkness that had been hiding behind the booze finally showed its face.

In the spring of 1986, while on holiday in Spain, I visited a Picasso exhibition. As I stopped at the first painting I felt a faint knock on the back of my head. And thus began a terrifying panic attack that lasted all the way back to Dublin.

Back home, the panic attack was soon followed by the "speeding" familiar to followers of the bipolar Carrie in the series Homeland. I thought too fast, talked too fast, could not rest, could not sleep.

By then, Professor Moore had retired, so I went to see Dr Pat McKeown of St Patrick's in the autumn of 1986. He confirmed Professor Moore's diagnosis. I was suffering from something with a lot of euphemistic names: bi-polar, cyclothymic, mood swings.

Personally I prefer the honesty of its classic name, the one as dark and deadly as a double- barrelled shotgun: manic-depression. But there is good reason to use softer names. Many people hear the word 'manic' with an extra "a" as in 'maniac'.

Actually the 'manic' part refers to mania which is simply the speeding, the agitation, the edginess familiar to followers of Homeland. At the beginning it can bring great clarity. It is important to note that Carrie was right about Brody being a terrorist sleeper. She can see the core of the matter more clearly than anyone around her. Her problem is nobody believes her because she is talking too fast. Tell me about it.

But mania or speeding is only the first half of a deadly cycle that ends in suicide for one in 10 victims. Let me try to explain that cycle simply. Manic depression is a see-saw. If you go up, you go down. To put it graphically, think of it as a scale of 1-10, with normal people at 5. But bipolar people swing between stops above and below the 5.

Some lucky souls like Napoleon are stuck at six, a point called hypomania, where you are full of energy. Before the swing becomes extreme, many bipolar people enjoy the euphoria of these early stages when they effortlessly do enormous amounts of work.

The late Professor Anthony Clare believed that being bipolar might account for Michael Collins's astounding energy – as well as his well known descents into moodiness and tears. Churchill, another manic depressive, mirrored Collins in the energy stakes. Maybe that's why they had a meeting of minds during the Treaty negotiations.

But as you move further up the scale, towards seven and eight, you find you can't sleep and can't sit still. Then you need medication to drop you back down. Conversely, you later need different medication to lift you up again when the swing sends you too far down the scale, through the blues and the black dog until you reach the dark wood of Dante's Inferno.

In 1987, I was hospitalised twice with severe depression. But within a year, with the help of a natural salt called lithium, which balances the swings, I was able to cope again. Today, I am totally free of both drugs and depression. Thank God.

In 1988, as soon as I could cope, I decided I had to do something to break the silence surrounding mental illness in public life. So I made a film on manic depression for RTE called Darkness Visible. Against the advice of those who said it would finish his career, singer Johnny McEvoy bravely went public with his problem.

The RTE switchboard was jammed for three days with messages of support. Johnny McEvoy became an icon of the struggle against ignorance. Since then, it has been relatively safe for public figures to share their problems.

In Darkness Visible I set out to dispel the stigma surrounding mental illness. This also meant slaying some sacred cows. The most sacred was the nonsense fostered by the theorist RD Laing and the film One Flew Over the Cuckoo's Nest: that mental illness was caused by society.

These led many liberals to be hostile to the medical model of mental illness, to dismiss drugs, to seek therapeutic solutions to severe malfunctions in brain chemistry. I am convinced that both the Jack Nicholson film and Laing (who turned up drunk on the Late Late Show) were indirectly responsible for many suicides.

Based on my own experience, and extensive research for Darkness Visible, I came to some firm conclusions about treating bipolar and depressive conditions. Some who work in the field may not agree with me. But at least I can say: I have been there, suffered that, found a way to get better.

By and large, I believe that while the causes of mental illness can be buried deep in personal history or in social pressures, the actual attack itself involves a chemical malfunction of the brain. Accordingly, I broadly support the medical model of mental illness.

That means I am sceptical about the role of psychotherapy and talking treatments at the start of a severe attack of mania or depression. If you wake up to find your house on fire you should not waste time probing the causes of the fire. First, put the fire out. Take your meds.

But as soon as the meds work and you are able to cope again, you may be helped by one of the talking therapies. Both cognitive therapy and choice therapy are successful in breaking long-term dependency on drugs. But the main advantage of talking treatments is to help you take stock of your life.

Paradoxically, a nervous breakdown may be liberating in the long term. Frequently you find you can face up to some fear that you buried lest you came apart. In my own case, apart from alcohol, a contributory factor was the collapse of my life-long belief in socialism.

Some men, and I am one, need to believe the world can be changed for the better. Socialism seemed the best way. But from the mid 1980s, as communism went into crisis, I began to lose my faith.

In 1987, I sought the advice of Dr Noel Browne. He berated me for having doubts about socialism, and behaved more like a commissar than a doctor. It left me badly shaken. Significantly, after I packed in socialism, and resigned from the Workers Party, I never again had another severe attack.

Socialist compassion seems confined to the public sphere. Left liberals pay lip service to the notion that society is the cause of mental illness. That means they tend to be hostile, not just to the medical model of mental illness, but also to mental hospitals.

These defective beliefs, plus a passion for collectives, have contributed to the current flawed fashion for closing mental hospitals and substituting so-called "care in the community". But "care in the community" far too frequently means mentally ill people walking the streets without any care.

We will always need beautifully designed and attractive mental hospitals as short-term sanctuaries. Such sanctuaries are critical during the first severe phases of a breakdown. Only when patients can fully function should they be discharged back into the community-and given cognitive or choice therapy.

But mental health needs to be fostered. Below I list three simple changes which I found helpful. But first, a piece of advice. Do not turn a depression into a major drama. Life is suffering, says the Buddha. Most of us suffer from slight mood swings, especially around Christmas when "fond memories bring the light of other days".

To prevent these blues become blacker, the following may help.

First, look after your body. Go for a daily walk with a dog. Take up swimming, which soothes both mind and body.

Second, avoid stress by taking note of time. Be punctual, and insist that others are. Deadlines are disaster areas to be avoided by doing the work in advance.

Third, take up meditation. Or a calming hobby which is itself a meditation. Fishing, knitting, pottery or any physical work with the hands helps calm the mind.

But the most valuable advice is in Rev Sydney Smith's letter (above) of 1820 to Lady Georgina Cavendish.

Smith was a liberal Protestant clergyman, a famous wit who was welcome in London's best houses, and a brave man who never concealed his support for Catholic Emancipation and the cause of Ireland.

But he was also bipolar. His letter to Lady Georgina shows he knew how to cope with depression by living in the now, keeping away from toxic people, keeping good fires, taking cold showers. Read, mark and inwardly digest.

Sunday Independent

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