There are more things in heaven and Earth, Horatio, / Than are dreamt of in your philosophy.
Hamlet, William Shakespeare
On the otherwise nondescript day in June last year that I found myself in a mental health hospital, I was convinced that I was a spy. That was fairly tame, by my standards. On a past occasion, I had been convinced that I was the ancient Egyptian lion-headed goddess, Sekhmet.
Discomfited by the central thoroughfare-like location of the room that I had been assigned with two other women, I unilaterally decamped to a quieter part of the hospital, where the common use toilet and shower were closer to the room thus shortening the trip for my wobbly, drug-addled body. My new roommate Sophia was an older woman who read her Bible out loud and talked to herself during all her waking hours. I would later find out that she had a schizophrenia diagnosis.
It took some time to become cognizant of why I was in the hospital. Heartfelt pleading with a cherubic nurse by the name of Anna to obtain the contents of my file failed to yield results. I need not have worried. I would recall my affliction on my own soon enough.
Two days prior, I had emptied my closet, neatly folded my clothes into bags and swept makeup and jewellery off tables and in anticipation of my imminent departure for Amsterdam for my covert mission, I showered, got dressed and draped my netela scarf over my head and shoulders. I picked up the cloth bag of birr notes and coins accumulated during a previous life in Addis Ababa, only to remember that church gatherings were no longer allowed due to the pandemic. I was not a habitual churchgoer, and had never even been to the Ethiopian Orthodox Church so it remains a mystery to me why I had elected to go there, least of all at 6 am.
Three months earlier, in March, I had been part of a public conversation led by a mental health advocate and friend. Another guest and I had shared our experiences of living with mental illness with the intention of raising awareness on it. It was a celebration of visibility and I had been genuinely excited about our effort. Afterwards I had taken to Facebook to share with friends what it had felt like to speak about this personal matter in public for the first time.
Bipolar disorder, my current diagnosis, is a psychiatric illness thought to be caused by an imbalance in the chemicals responsible for controlling and mediating the functions of the brain, particularly the polarity of manifest moods. Bipolar mania may trigger a break from reality, something referred to as psychosis. While manageable with medication, bipolar disorder has no cure, yet.
During and after the mental illness event, two women said to me that they too were living with bipolar disorder. It was the first time that I had encountered Kenyan women like myself who shared my affliction, apart from an instance in another hospital when another woman in my ward was immured in the ‘strong room’, a windowless room reserved for difficult patients, as I too had been. It had emerged through whispers that she too was similarly afflicted.
In my Facebook post, I quoted Audre Lorde’s poem, A Litany For Survival:
[…] when we speak we are afraid
our words will not be heard
nor welcomed
but when we are silent
we are still afraid […]
But there was one thing which only I knew, even as I proffered advice on how to cope with mental illness: I was not taking my medication, a cocktail of mood stabilisers and antipsychotics.
Medications, often after trial and error, can do one plenty of good. That said, they also curtail the magic, I feel. Indeed, medications prescribed for bipolar disorder, as well as attendant psychosis, draw their efficacy from suppressing the chemicals in the brain that give rise to heightened moods and altered reality states—psychoses—reversing their actions and effects.
For instance, dopamine, a neurochemical whose synaptic actions involve the experience of pleasure among others, is blocked by antipsychotic medication. It is the action of dopamine in the left hemisphere of the brain that leads to auditory hallucinations as well as in the occipital lobe in the back of the brain that leads to visual hallucinations, both hallmarks of psychosis. I was convinced that in abiding by my medication, I would be denied of these extrasensory, otherworldly sights and sounds that I deeply treasured. Part of me found my noncompliant approach cavalier. Also, I ran the risk of glamourising a severe illness, not to mention that admitting to medical noncompliance would make a poor role model of me.
Early in April, signs of my medical noncompliance surfaced. I had been wondering what appropriate and responsible responsiveness to the pandemic would be for me as a freelance journalist. In a fit of productivity, I created a ‘guerrilla journalism’ course, crafting a twelve-lesson curriculum over a sleepless weekend. I circulated it on WhatsApp, in my family group and to various friends, most of whom approved. One, however, expressed concern over my hyperactivity. Later, it would become apparent that I had been in the throes of hypomania: euphoria, increased energy with decreased need for sleep and heightened psychomotor activity are symptoms of this mood state. Fluctuations in moods and energy levels are some of the key characteristics of bipolar disorder, as are racing thoughts and flights of ideas. Panicked, my parents journeyed to Nairobi from their upcountry home to deduce what was transpiring. They promptly administered a long-acting intramuscular injection used to treat psychoses particularly in people prone to relapses.
For the next month, I was functional, going about life as normal. I took to keeping a self-indulgent, facetious Covid-19 diary on my Facebook page (I shall devote the entire evening to the manicuring of my extremities. It is imperative that I stave off my descent into ferality. If this continual state of inelegance persists, true love will surely elude me forever!). I started wondering whether such frivolity in a time of global despair was permissible and elected to abandon it altogether.
***
I am ambivalent about what we call sanity. I believe that madness can be a portal to wonder.
Sometimes I am convinced that psychosis is an odyssey into other dimensions. It is truly a thing of beauty and awe when the mind can perceive past the limits of the five senses. To see what is not visible and hear what is not audible renders one truly special, or so I believe.
But madness can also be a source of suffering—delusions, psychic pain—and for this reason I do not wish to glorify it. However, I also refrain from chastising myself for desiring to experience the enchantment that is possible. One cannot forswear the thrill that is mania nor deny the captivating nature of psychosis.
More often than not, I capitulate to the siren song.
***
To this day, I struggle to articulate the most beautiful moment I have ever experienced in my life.
On the morning of the day of my first psychotic break, I ventured outside and gazed upwards, towards the sun. It was an arresting moment, one of brilliant clarity and dazzling splendour. In that moment, I believed that I had understood the universe in its infinity, that I had grasped how order had been born out of chaos. I had stumbled upon a great discovery, one that infused me with tremendous pleasure and that was mine alone. Matchless ecstasy. I let myself luxuriate in the moment, lamenting its ephemerality. Should I refuse myself this kind of transcendence, ascribe it to biochemical processes?
Neuroscience and logic inform us that this experience, a visual hallucination, is simply an imbalance in firing located in the visual/striate cortex. That the very sensory stimulus that is light, such as that proceeding from the sun, which is transduced into a visual stimulus by the neurons in the occipital lobe, can be evoked by a function of mimesis by the same neurons in a hallucinogenic state. Hence, the visual neurons inform the brain of a beatific visualization that may not have been present, or at least not to such an extent.
I have written about my affliction many times. Most of these accounts are mythologies: reconstructed tapestries woven from strands of fallible memory. Dare I trust an unwell brain? Indeed, it is well known in psychiatry that losses in memory may lead a brain to confabulate imaginary experiences to replace these gaps.
I think about the first time I lost my mind most often. Only by fully comprehending what transpired can I hope to transcend it. Did it happen in a single instant, a lightning strike? Or had it proceeded slowly, gradually? Does my brain maintain its integrity in the face of these onslaughts?
Whenever I emerge from psychosis, I am faced with the onerous task of remaking my world anew. The cognitive distortions of my mind, having burgeoned unchecked, have wrought destruction on people and things.
And so it goes with this dark card that I have been dealt, this yoke that has me bound. Such are the tribulations of a mind unmoored, dealing with an illness whose frothing turbulent rapids are not easily navigable.
I like being adrift in parts unknown, but I have come to learn that it is not wise to dwell too long in a distorted reality.
***
In the hospital, I have a Zoom conversation with the psychiatrist. It is not time for me to be discharged yet, he says. I protest, secretly fretting about mounting expenses. Board, medications… they are all adding up. ‘I have to make sure you are coherent,’ he says. I wax enthusiastic about how much better I am feeling, not making any attempt to contain my impulse for flourish. He is not convinced that I am fully recovered and refuses to discharge me.
At mealtimes, we the patients assemble, queuing at the kitchen window for the dishing out of plates of wholesome, savoury, plenteous food: minced meat, rice, potatoes, spaghetti, the occasional fruit, and other delectable dishes. We sit at the table and eat. Some patients are raucous. Most of us are just simply ravenous.
Otherwise my stay at the hospital is imbued with serenity. When not asleep, I take to sunbathing outside, savouring the feel of the sun on my skin during the balmy afternoons.
I have a new friend, Farouk. He is tall, skinny and always dresses in a bulky brown jacket with many pockets and always sports a red beanie on his head. He delights in telling me stories about the life he leads when he is not here, not undergoing treatment for schizophrenia. He tells me about the things he will do when he leaves in a few days’ time. He does not want to return to his station just yet. ‘There are snakes there the size of you,’ he says. Farouk is in the employ of the police. He wants to travel down to the coast, but with the pandemic’s restrictions, he is not sure how he will accomplish this. Out of the blue, he asks me to marry him.
Another patient, John, strikes up a conversation with me. He reads a lot; always has a book under his arm. He narrates his past addiction to morphine. He tells me that it is impossible to find his veins now. We prod his flesh and indeed fail to find any visible veins.
‘What do you have?’ I ask Moses, a boyish, bright-eyed patient who often says hello. ‘I am not sure. Maybe schizophrenia, maybe bipolar. You?’ he replies. ‘Bipolar 1,’ I reply. We are seated outside, on the brick edging of a flower bed. When he speaks, he is achingly earnest. He is 24, and has recently quit his job. Sometimes he shouts a lot, for minutes on end. I cannot tell whether he does it out of anger or out of pain.
The day I arrived, there was a woman whose keening all day and all night pierced the heart.
When still in the throes of my delusion, I am completely lost within, oblivious of the goings-on about me. But when the insanity slowly recedes I become partially aware of my surroundings, and of my fellow mentally ill. I approach everyone with caution. I wonder what we must seem like to the staff of the hospital. There is a sense of wariness and sternness that some patients seem oblivious to. I have experienced it sometimes, the slightly forceful undertone accompanying a request to comply with a humiliating gluteal injection, or when I am prodded to take a shower lest I am reported to the psychiatrist for neglecting my personal hygiene, a misdemeanour which would further prolong my stay.
I have been eschewing therapy but the therapist comes to my room and speaks to me. She inquires how I am doing and provides me with some writing exercises which pertain to monitoring my behaviour, so that I can better predict when an episode is nascent. She suggests a book from the library, a memoir which fails to engross me. This bothers me, for I am a voracious bibliophile by nature. I wonder whether my lack of concentration is a side effect of the medications I am being given, which make me dizzy whenever I stand up.
For all my cynicism, I find the hospital a safe space, one where patients such as myself can find community and build meaningful connections, unlike the outside world where we are often misunderstood.
One afternoon I notice that there is a group therapy session taking place. Voluntary participants are asked to draw their spirit animal. I refuse to participate in the exercise as I do not know mine. As I find writing to be both an empowering and a restorative endeavour, I ask for pen and paper to better while away the time. When I have descended from the blood-dizzying heights of mania, I like to reflect on my journey as I try to achieve a sense of control over my mind.
When I think back on prior episodes, I find that my memory is often riddled with gaps. Whether this is a testament to the efficacy of the medications or to the transient nature of my hallucinations and delusions, I am not sure. I recall the apocalyptic visions, the devilish whispers of phantasms in my ear. The experience is tortuous and intense, and soon enough I will more likely than not be rescued by a zealous nurse advancing upon me with a syringe. Extraction from the jaws of madness mercifully often entails sedation.
Since my first psychotic break in November of 2015, I have slipped in and out of madness a few more times. My relapses result from a failure to adhere to medication. When the illusory slowly starts to occupy the interstices in my mind, reality recedes in tandem. It is difficult to pinpoint exactly when the lines start to corrode, harder still to know when the boundaries are overturned altogether. There are warning signs, but I often either fail to see them or to pay them heed. And thus I hurtle headlong into madness, time and time again.
I get upset when people think that the way I behave when I am mad is being done in the name of art—I have heard this at least twice—or when they think that I have a quirk, an eccentricity. I am also always upset at myself for expecting people to tell the difference between the mad me and the normal me. My indignation is unfounded as it is not their duty to look out for me, but I cling to it without justification. Surely there are better, more useful things to do than take umbrage simply because what is obvious to me is not as obvious to people who are too busy with their own lives to closely monitor what is going on in mine?
I find myself struggling to accept that I am one of the chronically mentally ill. My last relapse was two years ago, after all. I have been mostly ‘sane’. But surely I am no different from my fellow inmates? I have come to the realisation that I have a lot of work to do in order to remove the tethers of stigma, both societal and self-imposed.
When I think that I have survived the worst, fresh chaos unfolds, upending all.
But—tooth and nail, grit and tears, I mend, again. Because there is good in this world and because life is worth living, I rise from the deepest darkness with a cautious, defiant hope. I choose to be present. I choose to be grateful. I choose to heal. And slowly, slowly, instead of shrinking, I find myself expanding and dare I say, blossoming. I pour love into myself, and my heart fills up. And even at my lowest, I still find within me some kind of grace.
Photos By Joel Lukhovi.
