One of the reasons I wanted to start writing this blog was to talk about my experiences in navigating the medical world of psychiatric care in Australia. I was treated for bipolar 1 disorder among other things in both public and private hospitals for a long time before being labeled an addict and being treated again and separately within that alternative framework. I was amazed by the difference between these two different models of care and I am still amazed by this today. There's so much overlap between different kinds of mental health conditions and a lot of the time substance misuse disorder is one of a few conditions that someone might be grappling with - but for some reason, we still treat these two categories as being relevantly different in terms of how we diagnose and treat them, but also in terms of how we judge people who are given these diagnoses and how we teach those people to think about themselves.
I was officially diagnosed with bipolar one disorder long before I was diagnosed with substance misuse disorder, and my experience of the medical model follows that trajectory. When I was diagnosed with bipolar one, I had just completed a master's degree in law at Oxford University. I don't remember being diagnosed - I actually don't remember anything after my graduation until I woke up in a public hospital psychiatric ward in Hornsby New South Wales where I had been committed sometime later due to being a risk to myself. My condition was deemed to be very serious, I suffered full blown manic episodes as well as depressive episodes, and I went on to spend extended periods of months at a time living in psych wards over the subsequent seven years. I had very little freedom, even though I was very qualified I wasn’t able to work, when I spoke to my doctor about feeling better and aiming to discharge, he expressed concern that this was likely just my mania returning and that it wouldn’t be safe. If I took steps to discharge, I would have to be scheduled again. For my own safety. I was treated with Electroconvulsive Therapy three times a week for several months at a time because this was seen to be “the best and safest antidepressant that we have” for someone with my type of condition, as well as 8-15 types of medication at any given time.
These were not fun years for me.
But back to the point of this post. This was ostensibly medical treatment for a very severe mood disorder. I was told that my condition was not my fault - it was entirely beyond my control - there was nothing that I could do about it. Soooo…. Poor me, I guess. And that’s what it felt like. Poor me. Poor us. We were all there together in these wards, doomed and damned, with these awful, horrible conditions that nobody would wish on their worst enemies. We were miserable and every day was worse than the last. It was just so goddamn tragic. And none of it was ever going to get any better. The doctors and nurses were like peddlers of misery. Of course they aren’t all like that, there are some absolutely wonderful doctors and nurses out there who treat patients with mood disorders with care and nuance and genuine interest and hope and they are worth their weight in gold. But I was unlucky in this regard - the doctor who ran the unit was fascinated by my disorder and I became something of a guinea pig. Even now, almost 20 years later, I feel nauseous remembering how my treatment plan unfolded and the heavy hand with which pharmaceuticals were administered to just… I don’t know. Flatten everything in me. He told me not to bother trying to have a normal life. Not to bother trying to work again or trying to have a family. Just live near a hospital. “It’s not possible for someone like you.” There aren’t words to express the extent of the scars that were occasioned over these years, both emotional and physical in terms of my bodily function, tolerance and such. Also importantly, how I learned to understand the role of medication in serving my purpose to aid emotional regulation. Whatever I saw that “regulation” to be at the time. I learned that one pretty quickly and went off into the world to play my own increasingly dangerous games of self medication, mimicking my mentors knack for top and tailing pharmaceuticals depending on the mood of the moment. But for us, for now, the key thing here is that I was taught to believe that I really was totally powerless. Because someone with this condition should just be grateful to wake up in a ward and exist and go to sleep at night. Just be grateful you’ve got that much.
Fast forward several years (I’ve already taken way too many sloppy tangents to risk any more) and I am finally admitted to a substance misuse ward at a private clinic. It has been a very dramatic whirlwind in between (let your imagination go nuts) but for now, just know that we’ve landed here with a new label, we’re in another clinic on a different floor and a tentative introduction to something called the 12 step program of Alcoholics Anonymous as well.
I will try to keep this pretty tight so that I can make some of the points I set out to make and not get too caught up in my tangents - And the main thing that I remember about the comparison from this first admission is that I was so overwhelmingly happy and relieved to have this label of being an addict. I know that sounds kind of strange but at this point I wasn't entirely sure whether or not this new addict label might mean that I didn't in fact have bipolar at all and everything that my earlier doctor had said wasn't really true. Nothing is that simple of course and it has ended up being a combination of things - but at this point I already knew some of the little cultural differences between the labels - enough to help me come up with an idea like this.
So what labels am I talking about? What judgments do we make and how does this affect treatment and image?
Well like I said, people who have mental health conditions that are not related to drugs and alcohol told that the condition is not their fault and they are not to blame. While it would be a stretch to say that mental health and illness is not stigmatized, it is certainly not as stigmatised as drug abuse and addiction. There is a general and institutionalised empathy towards those suffering with mental illness that has become the norm. We don’t blame people for their illnesses - we know it is not their fault. However, like I said, the absence of blame and fault can lead to the feeling of powerlessness that I had when it is poorly managed in medical treatment models. It doesn't have to go that way, there are plenty of new ways of thinking about mental health and illness that can be empowering and give autonomy to sufferers, but certainly that was my experience of living and being detained in mental health facilities for long periods of time.
On the other hand, being told that I was an addict seemed to have the opposite connotation at least for me at this time in my life. I remember feeling really empowered really quickly after this label was given to me and it was a bizarre reaction at quite a tragic time (a testament to how incredibly traumatizing the years of treatment for bipolar had been). In my planned treatment for substance misuse disorder, I saw hope for the future, a plan that would help me get my life on track, a program I could work every day to make decisions and upon which I could build a recovery, people who knew what they were doing and how to live. This was everything for me that the mood disorder treatment program was not.
There’s so much more I could say, and hopefully will say, about the differences between the treatment paradigms as they exist in Australia for mood disorders and substance misuse type conditions. I’m going to park this one for now in the interests of trying to contain posts and not letting them blow out too much - and this one ended up carrying quite a lot of my personal story. I should say as well - my situation was extreme. No doctor should ever impress upon a young person that they are done for in this way; that their mental health condition is so terrifying and incurable that they should give up their dreams and be grateful for a simple life in a hospital clinic. This isn't a normal situation. But I think the story and comparison is still worth rehashing because we all have associations with one label or another that allow us to go harder or easier on ourselves for one reason or another, right? It's not any true thing about any particular word or category, it's just our associations and beliefs (which reminds me that I still really want to write my post about choosing from the infinite truths).
I don't think the observations here are theoretical or historical because of the dates in my story, they are just as relevant and real today as ever, and it’s still amazing to me that there’s so little opportunity for crossover. I don't even think these two categories are real distinguishable categories on any medical basis. I think this distinction is made in private clinics based purely on sociological grounds - that is, we treat addicts differently to people suffering from other mental health conditions. Everyone has the same amount of power, the same limitations on their control, the same imperative to surrender if they want to live in any sort of enlightened way. And there we are.
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