It was the night that Max was celebrating the completion of his PhD. We were sitting in a charming pub called The Jolly Woodman. Jim emptied a pocket full of e-cigs onto the varnished table. I made a roll-up and went out into the garden. He followed, asking how I was. When I said I […]

It was the night that Max was celebrating the completion of his PhD. We were sitting in a charming pub called The Jolly Woodman. Jim emptied a pocket full of e-cigs onto the varnished table. I made a roll-up and went out into the garden. He followed, asking how I was. When I said I was thinking of coming off my medication he looked aghast.

Jim and I share a diagnosis of bipolar disorder. We have both been hospitalised for it in the past. Jim has found a medication that suits him and is happy to take a small dose of a mood stabiliser for what he sees as a biological condition. “Our brains are different to other people’s,” he explained. “If you had diabetes, you wouldn’t refuse insulin.”

I always found this analogy frustrating and absurd. The brain is a vastly different organ to the pancreas. Mental health is not purely a chemical balance. To deny the existence of the conscious processes by which we experience ourselves in the world is to see ourselves solely as organisms.

I can’t speak for Jim, but my thought patterns and their resultant moods are not simply due to a synaptic circuitry problem that needs rewiring. I respond to internal and external events in a way that often fits the bipolar diagnosis, but I do not see this as a life sentence or the sum total of who I am. Cognitive behavioural therapy (CBT) has had good results with mood disorders. In my experience, I have always been better able to engage in psychotherapy when I have been on lower doses of my tablets.

I have been taking various medications for more than ten years now. My first psychosis was triggered as much by the mis-prescription of Prozac by a well-meaning GP as by my teenage cannabis use. I had not slept properly for a week in the run-up to the Iraq War (I am half Iraqi, half Scottish by blood, born here). Other episodes have occurred when I have been off my medicine, but were also related to secondary drug use and followed major break-ups or other traumatic life events. For a long time I was treating my medicine as a buffer, feeling I could get away with smoking weed, or taking whatever was going about. Some of it was frustration with the way I was feeling. It has taken a long time to realise what I desire is clarity, not altered states.

I have now been off my meds for nearly two months. I have told my parents and the team involved in my care. All have agreed that it is my right to decide whether or not to take pharmaceutical drugs. I have managed to keep relatively stable so far and have dealt reasonably well with any problems that have come up. My hope is as long as I get enough sleep, eat reasonably well, and try and get enough exercise, I should be alright. If any early warning signs occur, there is a plan to spot them and take preventative action. I have a great network of friends, and I’m taking evening classes and doing a voluntary job that I like. Although I sometimes feel troubled, it has been worth it, and I have found my concentration improve dramatically alongside my ability to think clearly. Having spent many years struggling to focus I can finally read again.

There is a recently invented mental illness called ‘non-compliance’, saved for patients who don’t agree to take their medicines. This disorder appeared relatively recently in the DSM-IV in a somewhat spurious manner. Fortunately, the team trying to support me have not as yet medicalised what has been a long-standing goal of mine – to wean myself off medicines and learn to manage my moods through making sensible lifestyle choices and utilising the mindfulness and CBT techniques taught to me by some of the practitioners I have met over the years. There is a risk to climbing out of a chemical straight-jacket that as someone naturally stress-vulnerable I might succumb to an episode of depression or mania. But for me, the greater risk is to live a cotton wool life where I lose out on the natural highs and lows that come along the way, that I am shut out from my own thoughts, dampened to the subtle human exchanges that form our daily lives, and annexed from the beauty of nature.

This article is not intended to be anti-pharmaceutical. Mood stabilisers and anti-psychotics have their place in a patient’s toolkit. But when they cease to be useful it is time to reconsider what I put into my body. If I had engaged more thoroughly in a talking cure at the start and not embarked unknowingly on a course of antidepressants perhaps this whole thing could have been avoided. The various medicines I have taken over the years, while preventing deterioration, have also kept me locked in stasis where the learning processes involved in mastering and discovering the self have been inaccessible.

The project of living is best undertaken sober. Lasting peace comes from the resolution of internal conflicts, not from playing with the brain like a chemistry set. Perhaps peace is possible yet.

Omar Majeed.