I have opinions. Wanna hear them? Bipolar Schizoaffective Disorder

Trigger warning: Suicide and the other related stuff.

World Neurodiversity Week is 18-24 March, World Bipolar Day is 30 March, Mental Health Awareness Month is October (May in the US), World Mental Health Day is 10 October, and World Schizophrenia Awareness Day is 24 May. I figured that an essay-thingy about Bipolar-Schizoaffective Disorder fitted somewhere in amongst those dates.

Attacked at the very root. Vincent Van Gogh said those words pretty close to when he shot himself, then died two days later from complications caused by the wound. Perhaps thirteen months after he cut off his left ear. Only six months after he was hospitalised—again—due to self-diagnosed manic episodes. The unadulterated pain. The crowded room of his mind with not enough doors.

Based on all the anecdotal evidence, he’s been retrospectively diagnosed with Bipolar Schizoaffective Disorder, which explains a lot really.

Bipolar Schizoaffective disorder is a mental illness where people experience psychosis as well as mood symptoms. The schizoaffective part sits in the middle of a spectrum with schizophrenia at one end and bipolar disorder at the other. This is because these diagnoses share many similar symptoms, like a mentally ill Venn diagram.

The symptoms are similar to those experienced with schizophrenia, including hallucinations. Is it there? It’s there, right? No? But it’s real? Things like hearing voices, seeing hallucinations and other unexplained sensations. My hallucinations involve visions, sounds, smells, textures, all telling lies and lies and whispers and not there but here I am. Lies.

I have two permanent psychoses. That’s where I dips my toes—feet—into the pot of full schizophrenia. I can hear singing in the electrical hum of inanimate items like extractor fans, vacuum cleaners, air-conditioning units, the fridge. Sometimes it’s not a hum—that hum is like low-key Enya—sometimes it’s people talking. Not that I can make out the words. It’s more the cadence, like you know the voice when a person is calling a horse race. Or two Very Serious People are discussing politics on a current affairs show. Occasionally I wander into the lounge room to see if the TV is on because the wordless voices are very real.

It’s never on.

And I have my people. They wait at dual bus stops on the periphery of my vision; just standing in their light blue 1950s United Airlines flight attendant uniforms. I don’t know why the uniforms and the decade and the whole different country, but psychoses are inexplicable like that. Generally my people are benign. They’re always there. Just waiting. Waiting for when my bipolar schizoaffective disorder decides to misbehave and then they move forward to say things. Never nice things, and they become more defined and rather malignant. They talk to me and tell me to do things. Think Russell Crowe in a Beautiful Mind but without the maths.

Bipolar schizoaffective disorder means that during an episode, not only do I have people and sounds, I will smell smoke. I taste Vegemite in yoghurt. I see lights in shadows and shadows in lights. Last time, the walls were awash with ants and flies.

Depression and anxiety have a lot to answer for when playing in the schizophrenic sandbox. My psychoses are permanent, but when I’m anxious, they’re like a disco ball vying for my attention as a strobe light flings its rays at every available mirror. Smoke, music, voices, hallucinations, and tastes that my tongue has deemed illogical but my mind has already prepared a recipe. They are all at once and it’s a lot of up and down to the side to the left to the side to the left now spin your partner round and round and here we go again. Exhausting. And dangerous.

Of course, depression is the cousin that pops up later and all the psychoses say, “Hey, man. We’re going to hang around for a while. Let’s ride some waves, dude.” Dangerous, long waves, where individual hallucinations stay for so long that the Venn diagram between reality and schizophrenic vision becomes a circle and the person—me. I’m the person—wants to take matters into their own hands.

It is certain that Van Gogh suffered from dangerous paranoias. He knew it. Van Gogh admitted himself to hospital many times and self-reported his visions, his voices, the smells, the textures. Hallucinations hurt and so he painted all of his while in pain. Anecdotal evidence says that sometimes Van Gogh’s depression and bipolar schizoaffective disorder symptoms were so appalling that he couldn’t paint. The dismay he must have felt because it is now known that painting was not a release from his brain, his mind, the voices, the colours, the all and the everything. His work was about control and a labour to create steadiness. Painting was about destroying the pain. It was a form of self-care, and when he couldn’t, it’s little wonder he bought, maybe stole—he was quite poor—a 7mm caliber Lefaucheux revolver.

Schizophrenic psychoses are confusing and frightening. It’s the constant battle to register the real in the unreal. But self-care and medication and therapy and support and education and understanding and things like World Schizophrenia Day: all of them are important.

If Van Gogh had have been treated with comprehensive therapy, a world ‘Yep, I’m Mental,’ day and modern medicines, perhaps his paintings might have sold in his lifetime, rather than posthumously when people thought of him as a ‘mad genius’. Van Gogh didn’t have access to medication except alcohol and dried plants that burnt much too quickly and were much too addictive and weren’t nearly as effective as what it said on the box.

Modern therapy for people who live with any shade of the schizophrenia paint sample cards involves medication, doctors with the entire alphabet under their names only rearranged into degrees from institutes of higher learning, and activities that include, among others, involvement in the arts, like writing sapphic novels or painting.

Van Gogh knew. His painting was his therapy. And from what anecdotal evidence is available, his participation in art therapy was not only looked upon favourably, it was actively encouraged.

It’s unfortunate that there a stigma about schizophrenia—“Oh! Look. That crazed gunman must have a mental illness. Let’s spin the wheel and blame…schizophrenia!”—but also one regarding many of the therapies that are encouraged for those living with the illness.

Generally, these therapies are actively discouraged in our everyday lives. They’re trivial. Our lives are much too busy to value art therapy or music therapy or novel writing or any other type of mindful mental illness therapy because those activities are for people who have time, you see. Nobody actually has time for that. We worship at the altar of busy-ness.

Imagine a person is encouraged by medical professionals to draw for thirty minutes a day. Perhaps they take time out of their work. Perhaps it’s after breakfast and it means that their day starts ten minutes late. Maybe it’s at two o’clock in the afternoon because that’s the only time they could get an appointment with their head. So they sit and draw. Thirty minutes. Per day. That’s it.

I can hear the replies already, and no, they’re not psychoses.

“Gee, nice for some!” (sarcasm font)

“I haven’t got time for that. I’ve got the Crawford account due.”

“There are more productive things to do with thirty minutes.”

“What a waste of time. It’s drawing, for God’s sake.”

“That’s for leisure. Come on, let’s get to work.”

Imagine if we said those things to a person recovering from an operation to repair an ACL injury and they were attending physiotherapy sessions. Inconceivable.

But, during an episode, people with schizophrenic brains will suffer an injury. You just can’t see it, which is why it’s difficult to tell when a person with schizophrenia is unwell. Society, and its fascination with Van Gogh and others with mental illness, constantly dips its toes into the Pond of Public Psychiatry—it’s the same pond that the Facebook Epidemiologists swim in—simply because of the number of celebrities Who Are Mental and come out about their illness to Create Awareness. There are memes. There is nodding. There is a lot of “I knew it,” and “I told you,” and “There was something about that one”. A lot of insta-diagnoses with sage advice such as ‘You’re going through a bad patch but what doesn’t kill you will make you stronger", which sounds inspirational yet is incredibly ironic considering that many people with bipolar schizoaffective disorder feel that death is vastly more desirable than their current situation. At least twenty-five to sixty percent of people with bipolar schizoaffective disorder will attempt suicide and between four and sixteen percent will actually die from suicide. They. Will. Die. By. Killing. Themselves. And despite the inspirational ‘what doesn’t kill you’ mantra, most of these people will not feel stronger if they live. There will be an overwhelming sense of failure, and self-flagellation, and despair at the knowledge that the highs and lows and noise and not-noise will go on and on and on.

But not if they sleep.

Lack of sleep, out of everything that’s awful about bipolar schizoaffective disorder, is cited as the most common alert for early signs of manic psychoses. I bet Van Gogh didn’t get a lot of sleep. A number of studies have found that the medication to even out the highs, the lows, the mania and the not, and the tearing at your skin so that your brain takes its passport and flies to Bali, does bugger all if bipolar-schizo-havers don’t get sleep.

Sleep disturbance—lack of sleep, broken sleep—any type of sleep disturbance, is kryptonite for people with bipolar schizoaffective disorder. After a week of CrapSleep™, I am more likely to dissolve into mania where I fly so, so high, and dive down to the darkest of the depths and wave forlornly at my family as my mania car, windows and doors locked, hurtles back and forth. After a week of CrapSleep™ my anxiety will be so high that it sneers at the mania trying to reach it. I am  super paranoid, and all my psychoses are having a communal picnic in my mind.

Those studies also say that seventy-seven percent of bipolar-schizo-havers who are deprived of sleep for one night subsequently experience mania and increased psychoses for up to two weeks. One night equals two weeks. 

There is a period of time in a day, a minute, a week, a year—probably not a year. That’s wishful thinking—called euthymia. Euthymia is a normal, tranquil mental state or mood. It is neither manic nor depressive. It is neither psychotic or empty. It is perfect. It is normal. It is not neurodivergent. It just is.

It’s the goal for anyone with a schizophrenic outlook on life.

Medication helps me get there. I love me some Diazepam and Olanzapine, people. Unfortunately it’s fleeting. Seventy-seven percent of bipolar-schizo-havers continuing to experience sleep disturbance even during euthymia. You know what that feels like?

It feels like you want to claw the skin off your face and cry so hard that you can’t breathe, all the while sitting so still because you want to enjoy the peace of euthymia and all its joys and quiet of the quiets and fresh air and eyeballs unpopulated by imaginary people. But you can’t.

Imagine euthymic moments as butterflies: fragile, beautiful, generally making people pause and admire. Now imagine a fucking enormous car. The biggest car you have in your country. Drive over that butterfly. Reverse and do it again. That is what sleep disturbance does to euthymic moments.

Sleep disturbances mean that I could write a thousand words or ten-thousand words or zero words as I lie in bed or sit at my computer or exist in a world in which I am convinced that I don’t belong or that my bus stop people are moving, the yoghurt tastes like Vegemite, and the house is on fire and the walls are awash with ants, and my legs don’t work and why am I empty? And I don’t want to be here anymore.

It’s luck of the draw—a Powerball prize—that people score a schizophrenic disorder. It can’t be cured. Surely they know that when they are handing out personality traits and so on as each kiddo is born.

“Here you go, little just-born baby. Well done. Oh! I need to give you this! Hmm. What should I call it? I know! Have this bipolar-schizoaffective disorder. You’ll be fine. Just take your medication, get some therapy, and get all the sleep. No problem. Off you go. Don’t worry about the voices, the people, the tastes, the pain, the darkness inside so much light that your eyes hurt. Oh, you won’t  kill other people. At all. You’re actually likely to kill yourself. Try not to do that too much. The big boss upstairs really hates the paperwork.”

World Schizophrenia Awareness Day is on the 24th of this month. Not just on that date, and not just during World Neurodiversity Week, or on World Mental Health Day, or even World Bipolar Day, or throughout Mental Health Awareness Month, but maybe choose any time to realise that some people, like Van Gogh, feel attacked at the very root of their tree where the leaves are blue, and sometimes purple, and the branches move around too much. If you have a moment, lay out a picnic rug under their tree, stay a while, and glare aggressively at those roots. It might give your person room to breathe.