People with bipolar affective disorder are frequently intelligent and fascinating. They can lead completely normal and often exceptional lives, sometimes with medication and sometimes without. But bipolar disorder can also destroy people. There is no moral to this story, but this is, I am very much afraid, not a story with a happy ending.
I first met Daisy when she was admitted to the local hostel for people with mental health needs in the 1980’s. I was on the management committee at the time. She had a diagnosis of bipolar affective disorder. She was in her thirties and had spent a long time in hospital following an acute manic episode. The illness had effectively destroyed her life. Up until then she had been happily married, with a young daughter, living in a nice house in a nice part of Charwood, and working in the town as an assistant bank manager. She was an intelligent woman who had great ambition. But the onset of bipolar affective disorder had changed all that.
As her mental illness took hold, she became more and more grandiose and disinhibited. Her work suffered. She lavishly spent money she didn’t have on ridiculous schemes. She began to neglect her daughter. She embarked on reckless affairs which put increasing strain on her marriage. Eventually everything imploded and she was admitted to hospital. During her incarceration her husband filed for divorce and got custody of their daughter. He kept the house and she became effectively homeless. By the time she was admitted to the hostel, she was thin and ghostly in appearance, hardly ever saying a word, afraid to look anyone in the eye, and on an extensive medication regime of mood stabilisers and antipsychotics.
Over a number of years, however, I saw her gradually change. Several different combinations and doses of medication were tried, and her personality and something of her old spark began to return. At the regular dinners the committee members had with residents, she began to converse more, and her intellect began to shine through. She was a personable, articulate, well educated and vivacious woman, with good conversational skills. In time, she moved on to a self contained flat attached to the hostel, requiring less and less support.
But then, over 15 years on from her first breakdown, the bipolar disorder began to kick in again, and she became more and more manic. She began to spend large amounts of money on huge quantities of luxury foods which she could not possibly eat, and which was inevitably wasted. Since she had a very good pension from the bank where she had worked, she had accumulated a large amount of savings which she proceeded to squander. She was disinhibited, swearing in a way she would never normally have done, and flirting indiscriminately with males and females alike.
Eventually I was asked to assess her under the Mental Health Act. We arranged for her to come to the CMHT offices. When she arrived the button on her jeans was undone, as was her zip, and her jeans were halfway down her buttocks. She had put on a lot of weight, and much of this was on display. She was completely oblivious to this, and when she saw me she told me to “fuck off” before I could even speak to her, directed an impressive range of swearwords at several invisible people in the room, then walked out again.
I caught up with her again a day or two later, when she came to see her care coordinator at the CMHT. Although Daisy appeared a little less elevated than the day before, she nevertheless spoke rapidly and intensely, and was very difficult to interrupt. I gradually told her that in my opinion she was exhibiting symptoms consistent with hypomania, and listed them, explaining their meaning and the direct evidence I had to support my opinion. These included pressure of speech, flight of ideas, disinhibition -- arising not only from her state of dress yesterday but also from numerous occasions in which she had spoken loudly and inappropriately about her romantic and sexual desires for a male friend of hers, and the reckless spending of money.
“None of that is true, and you know it! I’ll have you for slander. I have friends in the legal profession who will sue you! I’ve only got to ring them!” she told me with the absolute certainty that only the most manic (and deluded) can possess. “If you persist in carrying on in that tone, I shall have no alternative but to hit you across the head!”
“Daisy,” I began, as calmly as possible. “If you were to hit me, it would only confirm my opinion. You would never dream of doing something like that if you were well. I do think you need to be in hospital at present.”
“Well,” she said, “If you’re thinking of sectioning me, I shall just have to jump in front of a lorry! What do you think of that?”
I did not think this was a good idea. However, I also did not think she was likely to carry out this threat.
“Look, why don’t you take a little more medication. You might be able to avoid going into hospital.”
She thought about this – for about a millisecond.
“And why don’t you go and fuck yourself!” she answered.
Her care coordinator decided to contribute to the conversation. “Daisy, that is an idea. I could take you to see Dr Drinkwater [her GP]. Let’s see what he thinks.”
Daisy liked Dr Drinkwater. “He is a very good friend of mine,” she said. “I do trust him. I’ll ask him what he thinks.”
I heard later from her care coordinator that Dr Drinkwater had agreed with me, and had recommended an increase in her medication. Amazingly, she had agreed to this. She therefore avoided a compulsory admission, and in time her manic episode subsided.
Two years later, however, she became manic again. All the symptoms had returned. Once again I was asked to assess her under the Mental Health Act.
She agreed to come and see me at the CMHT, arriving like a galleon in full sail, and walked into an interview, saying, “You can tell that fucker I’m here, and let’s see if he dares to section me.”
I sat down with her. “Hello, Daisy. You know what this is about. You know I have to assess you under the Mental Health Act, and you know I have the power to detain you if I think it is necessary. However, the last time we were in this situation, that didn’t happen, did it?”
“I can’t imagine why you think I need to go to hospital. I’ve asked all my friends, and they all agree that there’s nothing wrong with me.” She proceeded to give me the full details of all the people she had consulted and what they had said, at breakneck speed, so that it was impossible to interrupt her or get a word in edgeways. So I just sat there for a few minutes, waiting for her to stop.
During this monologue something strange and unexpected started to happen. Liquid started to flood from her seat onto the floor all around her. After a moment of shocked surprise I realised that she was urinating. She clearly eventually realised this too. She stopped talking, in order, it seemed, to give it her full attention.
The cascade of urine seemed to be interminable, but probably lasted no more than 4 or 5 minutes. She obviously needed to go. The puddle on the carpet began to extend inexorably towards me. I moved my feet discreetly.
Daisy sat there looking totally unconcerned as steam rose around her and the room filled with a miasma of hot urine. When she had completely finished, and the Niagara of urine had finally abated, she said with immense dignity, “I do have a urinary tract infection, you know,” as if no further explanation were necessary.
This time, Daisy did go to hospital.