Stephen Fry: The Secret Life of A Manic Depressive (part2) transcript

[Music] the most dangerous sporting activity for women, which turns out to be cheerleading, apparently. Hello, Steven here. I don't know what number you're calling. This is a dressing room. No. All right. It's all the same old gang. Jimmy, how are you, my darling? Nice to see you again. You managed your pressure? Yeah. Oh, sorry. That's all right. No, that's all right. All right. There's another meme behind this public mask that one that is joshing and being amusing and trying to entertain.

And sometimes it's a very miserable and desparing one cuz I'm thinking, "Oh god, when's this going to be over? [Music] Sophocles and Socrates, the ancient Greeks that you and I talk about every day. Um, he there are times when I'm doing when I so hate myself and uh I'm actually kind of sobbing and kind of tearing at the walls inside my own brain while my mouth is, you know, wittering away in some amusing fashion. Ho ho, about whatever it is.

It wouldn't be television. Without television, you are nothing. I know that better than anything. I always have voices in my head saying what a useless bastard I am. But the voice is my own. It is my own voice just telling me what a worthless lump of [ __ ] I am. Are you surprised that I feel like that? I no longer am because I know that it's the result of my illness. I have a disease of the brain that I share with 4 million others in the UK.

It can be a serious condition. It's led me to being expelled from school, imprisoned for theft, and attempting suicide, all by the age of 17. Please welcome your host for the evening, Mr. Steven Fry. It's tormented me all my life with the deepest of depressions while giving me the energy and creativity that perhaps has made my career. It's called bipolarity or manic depression. Until now, I've tried to cope with it largely by ignoring it.

But I'm not so sure that that's been wise. I want to know how severe my condition is. So, I've taken part in the world's largest study of bipolarity, which happens to be in Cardiff. The results have shocked me. Now, zero on that scale is somebody who has absolutely no features of being bipolar at all. From what you've told me, you you would score probably about 70. you fit well into the realm of people who have, you know, full-blown manic episodes.

It's clear I have bipolarity more severely than I believed. So, I've decided to think again about possible treatments, investigate what's now available, and decide if I have to change my life dramatically. [Music] When you go on the net to find treatments for manic depression, you quickly discover there is no simple agreed approach. That's because people's symptoms vary widely, as does the severity of their condition.

It's a complicated illness that's not even diagnosed until a crisis point is reached. That was certainly true for me. I lived most of my life with it, unaware of what I had. Then 11 years ago, my crisis happened. My life fell apart after, I suppose, years of success. I'd just started a run in a new play in the West End. Reviews of my performance were critical. I suppose I was unhappy with my own performance. I clearly wrote that I'd tell to failure as an actor and I think I did but I didn't think one bad performance in a series of not very good reviews which were never savage would be enough to make me escape life or try and kill myself for that matter.

So there obviously was something else deeply a miss inside some terrible terrible feeling that it all had to stop. So did I give off any signs that I was in turmoil? One person who might have noticed is an old friend. I went to his party just three days into the play's run. You don't remember what mood I was in at that time, do you? I don't remember you actually being anything but your usual debonire self at the party.

I don't remember reading that many reviews of the play to be honest and I don't know that it was entirely that. I did feel that I'd failed in it I think but I felt that I had failed in absolutely everything. I'd felt I'd felt in my entire existence. And it's odd how one doesn't give off any signals of that. No. Well, I don't think you did. No. Because I all I remember at the party was people delighted to see you as always because you had not seemed incredibly out of sorts.

Have I ever come across as a troubled soul? No. You're somebody who has a strong consciousness of your social obligations. Yes. Politeness. you're worried about how the other person feels. You want to make sure that they they are um engaged in conversation. It's John Cle who is of course famous for his interest in psych analysis and things. He did once say that my politeness would be um you know would be the destroyer of me.

Like so many manic depressives, I may have looked happy, but inside I was hopelessly depressed. Within hours of Griff's party, I decided to act. Very early in the morning, I came down from my flat in central London to where my car was in the garage. Yeah. I went in there, sat in the car with my hand over the ignition, brought down a duvet, which is one of those preposterous details that always accompany something like a grand gesture or a grand attempt to kill yourself.

You have to think about it. And I thought, well, if I have the do very long, stop the air getting [Music] in. Had this image of my parents staring right in at me while I sat there for at least I think 2 hours in the car, my hands on the ignition key. And so I decided not to do it. I drove to the south coast to get a ferry. As far as the suicide was concerned, it was not that I decided I'd never do it again. I think it was more I just uh delayed it.

One reads of elephants crawling away to die. They don't want to be seen. It's a primal feeling of uh ending and severing all connections with everything that you have [Music] been. I really believed that I would never come back to England. I had in my head northern Germany or Denmark. get a huge thick white pullover and a pipe and um sit in a stone cottage and offer to give English lessons and learn to mend nets. I I don't know what it was.

A bizarre fantasy. Found myself in Hamburg and I saw these rows of you know newspaper headlines and fears for cry type thing and I stared at it in complete disbelief. I mean, it was absolutely staggered. They all are worried that I've committed suicide. That's the awful thing, isn't it? I can't believe I made people worry so much. When you feel you can't go on, it's it's not just a phrase. It is a It's a reality. I I could not go on.

And I would have killed myself if I didn't have the option of disappearing. I was away for a week. For my family, my disappearance was especially worrying at the time. I and I I I I don't know if I believe in sort of great sense of family that nothing bad has happened, but it just didn't cross my mind. And I'm talking that, you know, you might have done with yourself, been gone and done it. And then you rang me. You sounded rather small and lost boyish.

And I was absolutely terrified of saying the wrong thing to you to frighten you about quite how enormous it had been back at home. In some ways, more troubled than ever, I quietly came back to London and was taken into the Cromwell Hospital. I spent 3 weeks here and at the age of 37, a psychiatrist for the first time gave me a diagnosis of bipolar disorder. I don't think I'd heard the word bipolar before, but I do have extremes of mood that are greater than just about anybody else I know and can occasionally go wild enough for it to be real trouble for me.

So, in that sense, bipolar fitted. Part of me resisted it. Part of me thought, I don't, you know, it looks like an excuse. Another part of me was immensely grateful and pleased to know that some of the extremes of my feelings and behavior were, you know, had a cause. With the psychiatrist diagnosis came his advice for treatment. Like many other manic depressives, I was told to reduce the stress in my life. Take time off.

Stop working so hard. I came here to Los Angeles, walked this beach every day, got surprisingly fit, and thought about his other course of treatment, the drug lithium. That's the standard medication seven out of 10 of those with manic depression are advised to take. But it's an old-fashioned drug discovered about 60 years ago and feared for its power to take away feeling, all feeling, making you a kind of zombie. I refused his offer and have never taken it.

In fact, I've never been on any medication since that first diagnosis. But now, with my condition appearing to be getting worse, I'm wondering if I'm wise. Until now, I haven't wanted my mood stabilized. But perhaps I'm wrong. Perhaps I don't need to fear the medication. I want to know how someone else in my business has coped. what choice they made. Now living in London, Richard Drifus has spent most of his life battling bipolarity.

As with me, it's led him into all kinds of scrapes. Like me, he eased the pain of his mood swings with street drugs and alcohol. Unlike me, he was willing to take what the doctors prescribed. Has that been the right choice? In every conversation, sooner or later, I get up like this and then and we're gonna do this and we're gonna go here and I've recognized that at certain times my behavior has been um capable of being off-putting perhaps.

Can you tell us what you take? It's different things. It's things having to deal with manic depression and ADD and concentration and sleep and anxiety and lithium. Lithium was the very first thing I took for many many years and now 20 years later 23 years later I am just about not taking lithium. I mean there are those who were very afraid of lithium because they think of it as some kind of pharmacological zombie drug.

Did did you find that when you took it with lithium? I remember driving down Mullhull and Drive one night and all of a sudden I was aware after 10 days of taking it that I had letter boxed that I could feel this. It was an absolutely non-claustrophobic experience that took the top and bottom and said you could live here and I was very happy to do so. I married with it. I had children by it. Reclaimed a career if you want to put it that way.

Bring it on the barrel. I'm coming around again. [Music] So, we're talking about the late '7s. Oh, late '7s. Oh, gosh. Right. I I I changed dramatically. I said to my doctor once, I have become a person I admire in the last few years. I have wept more. I have said I'm sorry more. I have succeeded in endeavors that were impossible and blah blah blah blah blah. And I could not have done that without this courage. And he said to me, "It's not courage.

It is the absence of anxiety." And that is as true a statement. Richard had said yes to lithium and other mood stabilizers, and it's clearly helped him cope with severe manic depression. Perhaps I've been too hasty saying no to it, but I'd like to find out how medical science justifies dependence on drugs. Because as Richard tells me, once he was on them, he's had to stay on them. That's what brings me to Abedine and a psychiatrist with strong views about taking the medication.

I mean, here here are your mood stabilizers, for example, lithium. I mean, lithium was was used for periodic mood disorders two centuries ago, but it was also used as a treatment for gout and it was believed to have health-giving properties. It tastes salty, but it's not a good idea to sprinkle it on your food if you It's dangerous. It's toxic. It's toxic. That's Yes. For the kidneys and for various other things, isn't it?

It's not particularly healthy. That's the reason why when folks are taking lithium, they have to have regular blood tests. So those who say, "Oh, lithium is a is is is a zombie pill. It's a it's a it's it's a kind of chemical pharmaceutical labbotomy." Um this kind of idea to you is nonsense. Many patients report cognitive dulling with with many medicines in in psychiatry. And that's particularly true in folks being treated with bipolar disorder.

And some of that dulling of cognitive performance might not be due to the medicine at all, but might be a property of the illness, right? And that by not taking medication, you might make that worse. The danger is that that that folks and and we know this is the case that many patients with bipolar disorders don't take the medicine. colleagues in Edinburgh there looked at what happened when folks gave up their lithium and they showed that that not only did patients relapse as you might expect some of them to do but some of them relapsed a lot faster than the pattern of their illness before they'd started lithium I mean for example if someone stops and starts lithium you will have more episodes of mania than you would have had you never taken it at all if you discontinue your lithium in the first year off lithium the number of reported suicidal acts increases beyond the level that was there before because it means once you start you really have to stay on it for for good or or in the longer term.

Yeah. I clearly look preoccupied coming away from seeing Professor Reed, but it isn't because I'm worrying about his message. Take medication and stay on it. It's because for the last few days I've been feeling increasingly depressed. [Music] very sort of black stage at the moment and uh would love to be somewhere else other than here. Frankly, I'm fully aware I'm a very awful person to be with. I find it difficult to meet people's eyes.

I find it very difficult to connect to people. I find it very um I just want to be alone, frankly. I just praying that it'll pass basically because it's it's [ __ ] irritating and and I hate myself for it. I mean, I've never thought that I hear voices, but I do I do I do um I do have a voice telling me I'm a complete [ __ ] all the time in my head. Usually, when I feel like this, I hide away. I can't this time. For me, that numbing kind of depression comes three to four times a year and lasts a week to 10 days.

I spend the time in the house staring at the ceiling, still afraid to take anti-depressants or mood stabilizers like lithium. So, as you can see, I'm still very much in the grip of mood swings, but also still more afraid of the medication than the illness. Surprising as it might seem, this is a common reaction among manic depressives. A couple of years ago, I read a newspaper article by the parents of a 27year-old girl called Zoe Schwarz.

I wanted to talk to them about what was in Zoe's mind during her last depression. [Music] And it was 7:00. She hadn't come. I said, "Let's ring the police after supper." I remember at4 to 8 um the police came. In a flash, I knew what had happened. She went up to the end of the platform and she jumped very high and the train driver then said, "You know, it hit me at face level. She she'd had it all planned. Zoe was 27 when she killed herself.

She was beautiful, articulate, very bright with a master's degree from the London School of Economics. But she'd also spent almost 10 years trying to hide the symptoms of an illness that had already led to suicide attempts. Hello. Hello. Love you, Dad. Looking back on it now, what I know, and I do realize she was going up and down, but she hid it. She hid it from everyone. She would never accept it. She would never admit it to herself.

And had she admitted it, maybe she could have been helped. This issue of people refusing to accept that they have it is a particularly difficult one. And did she imagine was it pride in a way? That's what her best friend said. The week after she died, her best friend would came. and we were all together and she said it was her pride killed her. And she was writing in her diaries, all of which I found after her death, about these panic attacks, about these terrible fears she had, which she just hid from presumably herself to some extent because she never talks in the diary about being mentally ill.

She just talks about fear. Yeah. But she hid it from everybody. Despite the front Zoe put up, a breakdown eventually led to a diagnosis. She was presented with drugs to stabilize her moods. She resisted them. She used in her diaries the phrase, "I I don't want to be one of the lithium generation." It's a very modern phenomenon that Zoe was cut out to be a success. Her friends were successful. She had some very close friends from school.

They were all successful in their way. And she was desperate to be a success. And the idea that she would be a basket case for all her life, that she would be taking lithium to bring her down to sedate her, she could not accept that. Went into the hospital for a few days and then she she walked out. She hated it. She hated the people on lithium. Hated it with a lot of gowned people with lithium shuffling around a hospital.

And she would naturally think, I'm not supposed to. That's not my life. That dread seems to have propelled Zoe to her death. She talked to the psychiatrist who came to see her every week or every two weeks and she told him she wanted to kill herself. She died on Tuesday at 20 minutes past 12 and he rang us up on Wednesday at 9:00 and he said, "I think she did that yesterday because she didn't want to come into hospital and take lithium." She was really frightened of lithium.

She was really frightened of hospital and she felt there was a terrible stigma. that that stigma is is very very important and and it's I really do hope that you Stephen will be able to do something to about that in this program because uh this this is so harmful. It's revealing that Zoe saw going into hospital and taking drugs to calm her not as stages on the way to helping her recover but as treatment she couldn't bear to undergo.

[Music] And yet to my surprise when I was in Los Angeles recently I learned that ECT electroconvulsive therapy is actually still used in the treatment of manic depression. Andy Bman has become a celebrity in the US as a result of agreeing to ECT to curb the wildness of his bipolarity. I've never met someone who's been given electric shocks 19 courses of convulsion. It's an extraordinary thing and I just love to know what that's like and whether it worked for him.

So the next day I was in the hospital at 6:00 a.m. I was laying on a gurnie wheeled into a room. They connected the electrodes. They put the bite block in my mouth. So I woke up in recovery and I had no idea where I was except I knew I felt great. Oh, you did? Yeah. I was confused. My memory was a little shot. Yeah. Short-term memory loss is supposed to be the Yeah. And if people tell you, if doctors tell you it's uh not real, they're lying.

Mine was pretty long term. But you did feel better. I felt like the concrete in my brain had been kind of liquefied and just just shot through. And then my doctor said, "You know what? We need to do maintenance therapy." I said, "Okay, how many treatments do I need?" and he said, "Hey, 20, 30, 40, 50, 60, however many you need." I'm interested in how Andy ended up being given such extreme treatment. His background was a respectable middle-class Jewish family, but by his late teens and 20s, he was living out a truly manic existence.

You were cute and you had blue eyes. And so, you got a job as a as a dancer. Male dancer. Stripper. Stripper is the word. In fact, [ __ ] Exactly. You did. hustler, prostitute, I did it all. That kind of all ended. And then because you have to understand how the mind works, the manic mind. Okay, what am I going to do next? Wait, maybe I should go to law school. Maybe I should go to medical school. No, that doesn't work.

My sister's interested in public relations. Let's go into business together. We're making3 4 million. Out of control. So, I wrote this article for the New York Times magazine called Electro Boy because a nurse had called me Electro Boy in the hospital. And it was just a story, an 820word story about my experience with ECT. And then I'd have to say from that point on in my life, nothing went wrong. Andy's article became a best-selling book that was then optioned for a film.

Suddenly, the whole world knew Electroy. Electroy.com, Fighting Depression and Bipolar Disorder. All my closest friends have read your book and love it since they understand me slightly better now. I am 22 now and still suffering in bliss and agony. Bliss and agony. Good phrase. 20% of people with bipolar disorder kill themselves. 40% never able to function well enough and end up living with their families. Another 20% don't function at the level that they were ever going to be able to function at and you know work as clerks or cashiers or things like that. and 20% somehow stabilize, recover, and you know, just go on to lead extremely productive lives.

So, do you think it's Andy Bearman who beat bipolar or the doctors who the cocktails or? No, it's it's me who beat bipolar in tandem with a doctor that I saw for 10 years. I think I came around because after 19 rounds of electroshock therapy and 37 different medications, she said, "You're on your own. You can do it." Yeah. You're on your own. You can do it. Oh, you be. This is Steven. Hello. You're going to read your daddy's book one day and you're going to wonder.

She She has an electro baby t-shirt. For Andy, the treatment worked. But I still can't imagine feeling so bad that I would agree to electrodes being attached to my temples. But I was genuinely surprised to learn when I was talking to a British psychiatrist that ECT is still used on about 5% of patients. And for those with severe depression, it works better than any existing drug. It's only the terrifying images of when it was used in the early days without anesthetics and muscle relaxants that ensure the stigma around ECT remains.

The same stigma surrounds mental hospitals and psychiatric wards in the treatment of manic depression. About seven out of 10 manic depressives will have to enter hospital when they have a severe episode. They'll go either voluntarily or under what's called a sectioning order. Sectioning sounds to me just as dark and controlling as ect. So I went to a psychiatric ward in East London to see if my fears were justified. It might sound silly, but I think that's probably one of the most powerful pieces of paper in the country.

Really, I'm not joking. That's a section. That's a section paper. This is a section. You know that phrase, you should be certified. You know, he's certifiable. That is the process of certification in modern day language. Basically, I'm licensed under section 1283 act to detain someone for the protection of their health, their safety, and increasing in this risk crazy world of ours, the safety of others. That's all important.

Yeah. And two doctors and a social worker can complete this form. And this form will forbid someone from inheriting a will, leaving the country, applying for a passport, instructing a solicitor, voting. I'm not joking. You are not a citizen technically in the eyes of the lawyer once you're under this. This one says assessment. Now, this is a kind of getting to know you kind of section. Like I mean this section, section two, notice it's got nothing about treatment.

You can treat if you need to, but the essence of this is assessment. In other words, you've got 28 days to get to know them, to get to know why they've come to you, what their biological rhythms are like. They're eating, they're sleeping, they're thinking, they're feeling. What's been happening to them in the last few months? In other words, how did it all come to this? Welcome to Chew Ward. This is an acute adult open open ward.

No locks on the doors here where people can come and go depending upon what their legal status is, of course. Um, and this is pretty much it. Um it's a mixboard, 16 beds. Every single patient has a room of their own. This is the modern equivalent of the Victorian asylum. Almost like a student's um you know kind of JCR type thing. It's got a bar football and a television and institutionalish sofas. But what is perhaps unlike a student is the kind of stuff that goes on in here.

I mean, you wouldn't believe it, but these walls seem more than their fair share of shrieking and despair in their time than most walls do. I've never been inside a psychiatric ward before, so that was rather reassuring. But it must still be a harrowing moment for the family and friends of a managed depressive when they feel they have to put a loved one inside. An old friend spent years as a psychiatric nurse watching that struggle.

Did you regard it as a very serious step to section people? Oh, I think it's a hugely serious step to section people. Obviously, the vast majority of people who are um hyper manic or in a manic phase of a bipolar illness, what they don't have is insight into their illness and behavior. And and that's obviously why sections were originally invented, you know, was to be able to keep someone safe when their natural um instinct because of their illness would not be to do it themselves, you know.

Um, so the vast majority of people you talk to who have been sectioned will say to you, "I've got absolutely no idea why I was sectioned. I was perfectly all right." you know, and then you find out they were sort of hanging out of a window by one hand, naked, kind of, you know, I remember we had one young woman brought in once and what she'd done was she'd gone to a multi-story car park and she jumped from the from the roof of one car to another and she completely totaled about 70 or 80 cars.

Um, and she'd loved it as you would, wouldn't you? There she was. She was as high as a kite. She was laughing, you know, in this kind of manic sort of um gothic her way, but they're trailing along and her poor quiet sort of elderly parents. What the hell do we do? You know, and a lot of the time in those particular sort of manic phases, it's the families you feel sorry for because they're the ones that have to cope with the fallout of all the damage, emotional and physical, that their relative does.

But the remarkable thing is that we contain it. I mean it sounds kind of dark but I think it is a heroic place. It's secure in the sense of being a sanctuary. You know the old fashioned meaning the word asylum. It's a place to go when you're having a really really really bad time. We take people in like who've ded themselves with petrol who have tried jumping off flats who've taken vast amounts of paracetime who do not want to live anymore.

And we bring those people in and I would say that n and a half out of 10 punters leave here happy and well. Now if that isn't a result I don't know what is. Pessimism has always dominated our thinking about mental illness. It's just like the ghost of stigma reinventing itself as despair in this particular case. The idea is nothing you can do. Well, that's complete nonsense. Both Joe and Mark Salter, nurse and doctor, believe sectioning can help manic depressives.

But I also want a patient's view. Bethleam Psychiatric Hospital in London gave the world the word bedum, the place for lunatics. Liz Miller knows this place well. She was sectioned here twice when her mania went out of control. Does she think being locked up with other mentally ill people helped her to recover? just said the first time I was sectioned, I was in my flat with a couple of friends cooking stuff, but it was hard on my mania was driven by kind of fear and anger and there was a knock on the door and it's just like KGB calling and there was a policeman, social worker and a GP and they'd come to get me.

It's the paranoid world I was living in. I knew they'd come and get me and they did. Did you resist physically? Yes, I did. So you got a quick injection, you know. Well, at that point it's the police and basically they overpower you and handcuff you. So does this uh does this bring back memories? The old that's your Yes, that's your looney wing there. Um it does actually. Yes. And say it does make a cold shutter. Was it very secure and all locked?

Yes. We all had our own room saying you can't make a phone call. You can't tell anybody where you are. You don't have money. It was a week before I had a toothbrush. They inject forcibly for the first with antisycchotics. Antiscychotics and lithium as well. Right. And and did they help? I mean I I don't Yes, I think they did. I think in the acute psychosis they sedate you sufficiently so that the brain can begin to put things back together normally.

All told, Liz Miller was sectioned three times and spent a year in psychiatric wards. Looking back, she feels sectioning was a turning point. She now lives and works without taking medication and feels strongly that she has found another way to treat her manic depression. The psychiatric model, it says you've got this condition and you've got it for life and keep coming back, keep taking your tablets and there isn't a way to help people actually get back to normal.

So many people I've spoken to already who who suffer from bipolar disorder, man depression, whatever wants to call it, um just would not they believe be anywhere without their medication. Medication is like the trainer wheels on a bicycle. They're there to kind of help you get on that middle path. But when you've learned what it's like to lead a relatively normal, sane life, then you shouldn't or don't necessarily need those trainer wheels.

Need the wheels. Yeah. So you genuinely believe though that diet has a big part to play in mental health. I think it's it's the foundation. The foundation. Absolutely. I think if somebody isn't physically healthy and the brain is a physical organ, then you can't expect to be healthy. You have this theory about omega-3s which are more present in oily fish, aren't you? You actually need to have omega-3 molecules in order to get good membranes for your brain cells in order for them to function properly.

And supplements are as good. Well, I think they are. Yes. So, cod liver oil, that sort of thing. Yes. cod liver oil, flax seed oil, hemp seed oil. And you take a lot of these things? Yes, I do. I oily fish whenever I can, whenever it's on the menu. And I take every day um three grams of of cod liver oil. And you're pretty sure that your decision not to go on medication, but to do other things we talked about like slowing your life down and this kind of attention to things like amic is part of your being able to cope.

Absolutely. Yes. What makes Lizz's views even more interesting is that she's a doctor. She left university as the best young neurosurgeon in Britain. It was 6 months after that that she was first sectioned. All right. And you've got an MRI on the 20th. Yes. I'm on a waiting list for cancellation. Despite sectioning, Liz was never struck off. She returned to work as a GP, but just part-time to help her control the stress.

I want to know if it was or indeed still is difficult to get work. It's difficult to know with a long way to go till mental health is just accepted as part of every day you know part of the rich tapestry of life. Certainly a few years ago I would have said definitely that one wouldn't get the job. Have you ever actually held back details on your past? I have. Um certainly in the early days I lied unscrupulously and I recommended other people to lie.

The situation's changed in the last five, six years and because of the disability discrimination act, disability discrimination act actually makes it unfair to discriminate against someone on the grounds of mental health problems. And the practice that um I was making general practice, it's almost like I'm their token loon. I'm their proof that they have a modern approach to to you know medical care. They've got one of their own.

As both doctor and patient, Liz is convincing. But Liz says when she talks to psychiatrists about how she has a job and manages her manic depression, no medication, special diet, less stress, they're reluctant to believe her. Wait and see. You'll have another episode. Well, for 15 years, she hasn't. I, on the other hand, as you know, do have episodes. Not breakdowns as in 1995, but sufficient to worry those around me.

Q the QI dates at last. We've got them all. Do you want to put those in? My sister Joe helps look after my work schedule. Admittedly, one that would horrify Liz Miller, but I can't seem to live life part time. I have to work hard, even at the cost to my family. Then prepare to scream probably um the heaviest 15, 16, and 17. Bloody hell. I know. I can't go to New York on Friday, but I could go on Saturday and Sunday and come back on Tuesday, couldn't I?

[Music] Manic depressives are notorious for just going with their moods and not treating their illness seriously enough until it's too late. Ellie Oaks was a director of finance at BNQ, a highf flyier, but she also had manic depression. Except she wouldn't admit it, not to anyone, not even herself. As a result, Ellie took no medication. Her symptoms got worse, and eventually she lost her job, her marriage, and nearly her children.

Trust me to do the same. I want to see her because of the individual way she's turned her life around. With an accountant's eye for spreadsheets, she began to keep a mood diary. When I first did this graph, I was I was surprised. It looked like this cuz I I I just kind of take each one as it comes. I don't think about it. You rate from naugh to three. Mhm. your your mania and from naugh to minus3 your depression. So zero is as it were as a a stable mood.

And the highest it goes to is two. I notice it peaks at two. Three you would regard as unmanageable as as dangerous. Completely dangerous. I think I mean dangerous to myself. Yeah. And to the happiness of the family and peace and everything else. What Ellie means is when high she loves to spend and spend. Forgets what she's left burning on the cooker. sleeps 4 hours a night for 8 weeks and has the energy to update her new company website at 3:00 in the morning, but when she's done, she can't get out of bed.

A lot of sleep. So, we're getting up to 17 hours a day. Um, so, and I I just have to I can't do anything about it. Um, 17 hours a day. Yeah, it's pretty it's pretty bad. Cats wouldn't be proud of that. Yeah, absolutely. No wonder partner Paul takes a close interest in how her moods are developing and when she's being creative and it bubbles just into the one one out of three of that scale then it's manageable. If it starts going above that then we intervene right with drugs with medication with medication um or initially we'll say right okay stop start stepping back start relaxing start working less hours and sometimes it works sometimes you can actually um take the illness and work with it so it doesn't get any higher and is she sometimes resistant she enjoying the mania so much she doesn't want to yes and sometimes the well look I need you to take that tablet just so it doesn't go too high can be a threat.

I don't want to take it. And then you have to have the argument. When we think of mental health, we think of, you know, men in white coats. Has it ever come close to that? We've reached a situation where we've accepted we couldn't cope at home. And Ellie had to go into hospital. There was no chance of her getting well on her own without support and specialist support. So at that stage had to go into hospital. And that was at that stage for 10 weeks.

Wow. How how long ago was that? That was two years. Two years ago. So, the children were all, you know, aware that mom was ill. Yes. And and how did you explain it to them? Um, mom is ill. She has to go into hospital and the children would say, "Why?" It's difficult being a mommy sometimes because you you feel guilty about it and you feel like you should be, you know, you should be normal and be sensible and responsible and sleep eight hours a day.

You can be sensible when you and you are normal. Right. Okay. Exactly. Part of you. I I couldn't imagine you without it. How many mums do you see drawing pictures, painting, bead making, jumping up and down, running around making jokes? When I'm in those times when I have ideas and I want to do things, they don't get fed up with it. It's like someone's got um like a special voice. That's a gift. This is just like a special voice but better.

Oh, all personalities are balanced out by something. Yeah. And moms just happens to be that her creativity is balanced out by her going to sleep. Yeah. Does it touch you that they think you've got a gift? I can't describe what that feels like. I just um It is It is really touching. It is, isn't it? Yeah. Ellie's mood diaries clearly let her see the big picture of her condition, and I'm impressed at how open she is with her family about her moods and behavior.

I've never mapped my own moods week by week, year by year. Perhaps that allows me to avoid seeing just how frequently they occur and how strongly they shape my life. An obvious manic sign for me, as it is for Ellie, is excessive shopping and spending. Now, psychiatrists encourage manic depressives to notice wild behavior and then hold it in check. To that end, they not only offer drug regimes, but more and more psychotherapy.

One talking therapy that they say proves useful is called CBT, cognitive behavior therapy. It emphasizes changing how we think about what we're doing. I've never tried it, but I've often worried about how I shop when I'm manic. So, I've asked Jan Scott, an expert in CBT, to come and try to help me keep things under control. I've probably got about nine digital cameras. How many pictures do I take? None. Absolutely none.

Let me see. Now, here we got satnavs. How many a few? I've got about five satnavs. Digital DVD projector. That's an interesting thing to have, don't you think? What people always tell us is it's that it is it is driven. It's almost like an addiction that they don't feel able to stop it. I have 12 computers. I must have something between 14 and 20 iPods. I know a fair number of people are in for toys for the boys, but they don't have 14 iPods.

They don't have 13 computers. I tell you what it is. What you've discovered is that I'm insane. I am actually mad. Good to see you. I'm really well. How are you? Oh, have you got the new Mac Mini? That sounds Yes. I'd love to. That's fantastic. People do it and they feel even more stimulated, more excited about it and it it feeds into this desperate vicious cycle. And so one of the things we try and do with people is to recognize it absolutely right at the start of when they're becoming hypermanics.

Don't want to be a killjoy here. Yeah. Is this cuz you really want this? No, this is really practical and sensible. Believe me, this is brilliant. Because you've only got 12 at home. Yeah, but I I know what you mean. But I see I'm looking sweat now. No. Um could you stop yourself? Probably wouldn't. I mean in the early mid 80s I had 11 motorc cars. is my treat and I'm aware that even if it were irrational, the fact is I work so [ __ ] hard that this is the few pleasure I get.

Supposing somebody turned around and said, "Look, this is going to cause trouble if you do this. If you go home with us today, you know, it's going to be a bit of a fight on I would stab them in the throat with a pencil." Way, you didn't stop me, did you? Unlike in analysis where you might be trying to look at subconscious processes, you're actually trying to look at the thoughts that people have that are very prominent in their mind and you can use that to look at how that influences their mood and their behaviors.

You'd want to help people identify the risks of when they become a bit disinhibited and how they could handle that. Can you reduce the risks in a behavioral way? Can you change people's behaviors? Jan tries hard with me, but I've had years of practice. Will I undergo a course of cognitive behavior therapy? Not yet. I like giving my manic side full reign at times, although I recognize I'm lucky I can afford my excesses.

But I am interested in how cognitive therapy can be used with manic depression. When Jan tells me about a young girl in North London who wants help because the depressive side of her bipolarity is making her feel suicidal. I want to meet her. Cordelia. Hi. How nice to meet you. I'm Steven. Hello. Hi. Theresa. Theresa. You're you're Cordelia's mother. Yes. Very nice to see you all. Come in. I mean that's what you say.

Yes. Gosh, what a house. Go down the steps. The photos on the wall tell the early part of Cordelia's story. A clever girl at school, a photographic memory for learning, and a creative urge to write a novel at 14, then Oxford. But that's where the symptoms began. A third of each month, she'd be depressed, the rest manic. By the time of her finals, her memory had gone. After university, her condition worsened and she was eventually hospitalized.

Well, what's your Do you want to look at the mood scale? It's in the kitchen. Oh, I'd love to. Eight. Inflated self-esteem, rapid thoughts and speech, counterproductive simultaneous tasks. Yes, I recognize that's about where I was when I was in hospital about eight. No, I think you were at nine. I was not I was not lost touch with reality. I was not paranoid and vict vindictive. Cordelia's manic side frightens her mother.

Nice boys. They look like a nice Every time I go to the station to meet her, I remember the night that she didn't come home. I met every train every hour just hoping and hoping that she'd be walking down the steps and she wasn't. She'd um just allowed herself to get picked up by somebody in a bar or she'd picked him up and she'd just gone back with a stranger for the night. Cordelia seems to be drawn to people who I wouldn't expect her to be drawn to.

Let's say when I think that she's getting a bit dangerous, I just don't let her out or I go out with her. [Music] It's going to get worse. This is the thing, Stephen. I am not going to be a lawyer or a doctor or something with my illness. I can barely I'm working part-time as an assistant at literary agency. I've been an assistant four years and I'm doing a part-time MA. I cannot work full-time. She depends on us for absolutely everything.

Do you seriously think then she can't cope without you? I know she can't. I think half when we're left with Norman on his own, the story doesn't work for me. And I just found it quite depressing. And I was wondering if just I didn't get it. Is this anyone an old England that doesn't fit? Cordelia's fears about her future depress her. That does come across. But even worse is the effect her depression has on the one activity she loves, her writing.

That's what she desperately hopes Jan Scott can help her with. tighten up into it. You've got this terrible problem that as soon as you slip a little bit below a normal mood state and you're depressed, your creativity disappears. I suppose what I had thought is that when I was depressed, I would be able to write about being depressed, but I actually can't. I can't even write about being depressed when I'm depressed. I can't really write about anything.

For about the first five or six years of having the illness, I wouldn't ever be depressed more than a couple of weeks. literally last time and the time before towards the end when I'd been depressed for sort of nine or 10 weeks, I just thought, you know, I've never been depressed for this long before, I could never, you know, this could be the one that I never come out of. I'm never going to be able to write again. I'm never going to be able to, you know, go out and socialize again.

I'm never going to be able to really do anything again. I mean, what does it say about you if you can't write? What's going through your mind? Can you say it? She's very upset. She's picked up bag. She looks like she wants to walk out now. I find watching later Jan talking Cordelia through her feelings very moving. It's fascinating to see how Jan uses cognitive therapy to unpack the deeper emotions within Cordelia. But the most important thing I I felt here was that she was identifying something so fundamental to her view to of herself and there's a point at which she can't even say the words about how she feels about it.

This issue of she had grown up being seen as exceptional and she felt the had taken this away from her. I don't mind a bit of weakness in other people if it's sexy sort of weakness. I hate weakness in myself. Think of myself as very strong and glittery and shiny and funny. Right. The writing is something that I'm good at and that. So if you can't do that, that's the final straw. Yeah. Her self-esteem is partly tied up in her ability to be a writer and she's had a lot of positive feedback about that in her past.

Yes. And we've got to actually address that in terms of her beliefs because otherwise becomes this vicious cycle and becomes very dangerous because she becomes she potentially could become quite hopeless and that makes people very vulnerable. [Music] Generally thinking about suicide and death is not good for me at all. So that's why I don't don't want to. With the stigma that still surrounds mental illnesses like manic depression, I thought Cordelia was very brave allowing me to witness such a private moment.

Like the others I've met, she was prepared to be seen and heard so that all of you know better about the illness we suffer. Just like me, Cordelia has come to accept that she has a chronic condition that will be with her for the rest of her life. That's a painful realization. But she also learned from Jan Scott that it's like having asthma in that while it's always going to be there, the key for most people is in finding ways to reduce the attacks and to make them less severe.

That's where treatment comes in. Cordelia accepts it. But what about me? After all I've seen and heard, I'm still unsure. I feel reluctant to embrace a life on medication, but I do fear the intensity of my moods and where they can lead. I just say I don't want to kill myself. I just wouldn't be I wouldn't mind dying. It's terrible thing to say. And I hear myself and I think, "Oh my god, my mother's going to hear me say that and think how awful, Steven.

What do you mean you wouldn't mind dying? That's a terrible thing to say." And all those who love me would say, "What an awful thing to say." But a lot of them would say, "Yeah, I know that feeling, too." And yet, as with all bipolars, there is this other side. I love my condition, too. It's infuriating, I know, but I do get a huge buzz out of the manic side. I rely on it to give my life a sense of adventure. And I think most of the good about me has developed as a result of my mood swings.

In this journey, I asked many of my fellow manic depressives how they balance this contradiction. I asked them if they could press a button to release them from their bipolarity, would they do so? Most, despite traumatic moments in their life, said no. So, after all this, what would I do? I wouldn't uh press the button and live a normal life. Not for all in China. [Music]