‘There are no words for the horror’: the story of my madness
It’s disturbing, at almost 60 years of age, to be diagnosed with an illness that you’ve suffered from your whole life without it ever being named. Your first reaction is to protest. I protested, insisting that bipolar disorder is one of those notions that are all of a sudden in vogue and get pinned on anything and everything. Then you read what you can on the subject, you re-examine your whole life from that angle, and you realise that the shoe fits. Perfectly, even. That all your life you’ve been subject to this alternation of excitement and depression that is of course all of our lot – because all our moods change, we all have highs and lows, clear skies and dark clouds – only that there’s a group of people to which you belong, along with, it seems, 2% of the population, for whom the highs are higher and the lows lower than average, to the point that their succession becomes pathological.
However, where the description doesn’t fit at first glance has to do with the so-called “manic” phase of what until the 90s was called manic depressive psychosis. The manic state is when people strip naked on the street, or suddenly buy three Ferraris, or feverishly explain to anyone who wants to hear it that what they’ve got to do is eat guavas, lots and lots of guavas, to save humanity from a third world war. I knew a young guy who did things like that and who, once the crisis had passed, was appalled by what he’d done. He killed himself, as it seems up to 20% of people with bipolar disorder do. I felt sorry for this brilliant, desperate young guy, and never thought I suffered from the same disorder as he did. I was depressive, yes. In addition to what can be called empty periods, I’ve been through two phases of real, severe depression, the sort that lasts for several months, and during which you hardly ever get up, you can no longer accomplish the most basic tasks, and above all you can no longer imagine that things will change.
That’s the hallmark of depression: you can’t believe that one day you’ll get better. Well-meaning friends say: “You’ll be fine, you’ll see.” But you only look at them with dismay and even start to resent them: they’re so wide of the mark. It’s so clear they haven’t got a clue. When you’re in a depression you think that you’ll never come out of it, that you won’t come out alive, that the only way out is suicide. If you don’t kill yourself, however, sooner or later you will come out of it, and then once you’re out of it you cross over into the camp of the well-meaning friends and can no
longer imagine this state of intolerable and seemingly endless distress.
When I was young, I had a bad trip on hallucinogenic mushrooms. They sent me to hell, which is, by definition, frightful and never-ending. But I was lucid in my nightmare, and told myself: “Don’t panic. I took poison. Its effect will last as long as it takes me to digest it, in eight or 10 hours it’ll be over, I just have to hold on until then.” I said this to reassure myself, it was reasonable and true, but at the same time I wondered: “Can I hold on until then? In eight or 10 hours will I still be alive?”
I lived through it, and I know that once you’re back among the living you put this hell into perspective, you quickly forget the horror. As LouisFerdinand Céline puts it in Journey to the End of the Night, “The biggest defeat in every department of life is to forget, especially the things that have done you in.” Anyway. Unfortunately for me, I’m no stranger to depression. But what I still didn’t know during my first psychiatric consultations is that, in the definition of bipolar disorder, the pole opposite the dive into depression isn’t necessarily a state of spectacular euphoria and disinhibition that leads to social suicide and often to suicide itself, but just as frequently what psychiatrists call hypomania, which means in plain language that you act like a fool, but not to the same extent.
You’re bipolar type 2: agitated without necessarily being euphoric, but sometimes also seductive, flirtatious, very sexual, outwardly very much alive, but inclined to make the type of decisions you regret the most, while being dead sure that they’re right and that you’ll never go back on them. Then after that you’re dead sure of the very opposite, you realise that you’ve done the worst thing possible, you try to fix it and do something even worse. You think one thing and then its opposite, you do one thing and then its opposite, in frightening succession. But the worst is that if you’re like me and are used to analysing yourself, once the diagnosis has been reached and the mood swings identified, you gain hindsight – only this hindsight is of little use. Or if it is, it’s just to see that no matter what you think, say or do, you can’t trust yourself because there are two of you in the same person, and those two are enemies.
* * *
It was totally predictable, since manic excitement is invariably followed by a dive into depression. An atrocious period. In the first phase I was elated at the prospect of a new book and a new life, full of promises and conquests. I rented quite a nice apartment on the Rue du Faubourg Poissonnière in Paris. I bought a Bluetooth speaker and took out a subscription to Deezer, both of which I imagined, oddly enough, as attributes of my new life. Then I end up as lonely as a rat, without a woman, or impotent when by chance I bring one home, my neck covered in dandruff, my cock blistered with herpes, unable to write, having lost all faith in a book project which a few weeks earlier seemed so right, so necessary, so doable, as all I had to do was start by describing what was happening to me. The problem is that I don’t know what’s happening to me, and I’m no longer able to tell myself or anyone else anything at all.
To live, you need a story, and I no longer have one. My life is reduced to the path between my bed, where I bathe in a terrible sweat, and the terrace of the Café Le Rallye where I spend hours smoking cigarette after cigarette in a dazed stupor. Even today I can’t walk past this cafe without a shudder. For almost two months I barely washed or changed my clothes. The bathtub got clogged and I did nothing to fix it, and even when I went to bed I barely changed out of my depressed man’s garb: shapeless corduroy trousers, an old sweater full of holes, trainers whose laces I’d removed as if in anticipation of the precautions that would soon be imposed on me in psychiatric hospital. I don’t stop trembling, objects fall from my hands. If I put jars of yoghurt in the fridge, they slip and crash on to the kitchen floor. Yoghurt I can deal with, but one day I wanted to move a little statue of the Gemini twins, which I’d placed on a shelf like an altar, by a few inches, and I dropped it, too. It shattered. I stood there for at least an hour, looking at these pieces of terracotta which had been the secret symbol of my love, between my feet on the parquet floor, and I thought: there you go, you couldn’t say it more eloquently, everything was broken, nothing could be repaired, it was all over.
* * *
My internment at Sainte-Anne psychiatric hospital lasted for four months. The medical report, which I have in front of me, begins with this summary: “Characteristic depressive episode with melancholic elements and suicidal ideas in the context of a type 2 bipolar disorder.” And, a little further on, here’s how the patient is described on admission:
“Moderate psychomotor retardation with hypomimia, sad expression but emotional reactivity. Despondency, anhedonia, abulia, significant moral suffering, asthenia with a considerable psychic and physical toll incurred in carrying out daily activities. Melancholic elements with pejoration of the future and a sense of incurability. Ruminations, feelings of guilt towards loved ones, invasive suicidal ideations …”
You don’t have to master psychiatric vocabulary to understand that I wasn’t doing well. If you want to go into the nuances, “significant moral suffering” is worrying, but less so than “intense moral suffering”, which I was soon to experience, and which is itself less worrying than “intolerable moral suffering”. I’ve experienced that too, I don’t know if there’s a fourth. In the past few days, my already not very glorious state has worsened.
From one day to the next, from one hour to the next, I had gone from agitated to catatonic, and this state so alarmed my sister Nathalie that she made an appointment for me at SainteAnne. That’s how we ended up on the top floor of a modern building on the edge of the hospital compound, in front of a cordial, 60-year-old man in a white coat, with bright blue eyes and the quiet authority that characterises what’s known as a bigwig – even though no one ever talks of anyone being a little wig – who, seeing me in the state described in the report, decides to admit me straight off. I don’t go home, they put me to bed, we’ll have to wait and see for how long.
He stresses the notion of illness – very different from that of neurosis, which has dominated my adult life. The question is not to discover its origin or to understand why I’ve spent my life lugging such a big load of shit around in my head. The fact is that I’m sick, just as sick as if I’d had a stroke or peritonitis, so they’re going to lay me down and look for the right treatment, and they don’t hide the fact that they’re groping in the dark and that they might not find just the right thing for me right away. “But what we can do until we find it,” says the bigwig, “is keep you out of harm’s way. And don’t worry, we’ll get you out of here as fast as we can.” Hearing this, I heave a sigh of relief: I’m sick, I’m going to lie down, stop fighting, let things take their course, they’ll take care of me, and for starters they’ll shoot me up big time.
* * *
To return to the medical report: “Inclusion in a protocol with twiceweekly administration of ketamine. First three infusions: good tolerance, thymic improvement.” Ketamine, for those who don’t know, is a horse anaesthetic that people use to get high, and which in recent years has been found to have antidepressant properties. This is my introduction to high psychiatric chemistry. Before and after each session, the protocol includes my being given a questionnaire about my desire to live or to die, my suicidal impulses, my “pejoration of the future”, etc.
First infusion: 40 minutes, not one more or less, and when it’s over, it’s over, from one moment to the next. But during these 40 minutes it’s an XXL high. Lying in bed, I remain conscious, perfectly conscious. I can feel time passing. I can hear the doctor and the nurse talking softly. But I get the impression that they’re far, far below me, lost in the landscape above which I’m floating. Because I am floating. I’m drifting. I see everything. I’m perfectly calm, perfectly fine, I’d like it to last for ever. It’s like the descriptions of near-death experiences, and of heroin, of course. The heroin that you should never touch because it’s so good. I’m glad I’m interned at Sainte-Anne if they’re going to drug me so wonderfully. I feel good. After the first three infusions I still feel good – my tolerance to the drug is so encouraging and my thymic improvement so obvious that I’m already talking about leaving, and not just about leaving the hospital, but about leaving the country. With ketamine, work is back on the agenda.
“Fourth injection: bad tolerance with intense moral suffering and request for euthanasia.” Things take a turn for the worse, we’re into the rough.
The night before the infusion, I freak out. Although I’ve forgotten so much, I remember very well that my anxiety had its starting point in one of the most perfidious aspects of bipolar disorder. When you’re in the depressive phase, there’s no getting around the fact that you’re there: it’s horrible, it’s hell, but at least you can’t be wrong about it. What’s insidious about the manic phase is that you don’t realise it’s a manic phase. Especially when it’s only hypomanic and you’re not stripping off in the street or buying a Ferrari. You tell yourself that you’re fine, that everything’s all right. After all, that can happen: it’s normal, desirable even. You know it won’t last for ever, but when it happens you have every reason to be happy and not to tell yourself that it’s a trap. In my case, however, there’s a good chance that it is a trap, another blow that the disease has in store for me. Because it’s no longer me but the disease that wields power over me.
In the morning, all I want is the ketamine shot that will send me to heaven for at least half an hour. I want it so much that, fearing I won’t be given it if I confess to my psychological state, I say in the questionnaire that I didn’t sleep well and that I had some dark thoughts but that in fact I’m fine. The drip begins. I welcome with gratitude the blissful liquefaction, and then very quickly things take a turn for the worse. I’m heading for death. It’s clear: I’m heading for death. The doctors murmur softly to the right of my bed, I don’t understand what they’re saying but they must be reciting verses from the Tibetan Book of the Dead to accompany me to the Bardo. There’s a light above me. I have to go there. I have to go there. I mustn’t miss the exit. I mustn’t remain in this in-between state, this bad life. Everything must end and the suffering must stop, for good. Several times I go to the enormous effort – when you’re on ketamine, every word costs you dearly – of repeating “I want to die, I want to die.” Instead of two doctors there are now four or five in my room, which becomes too small, much too small, a small box that shrinks even more, and, stuck to the ceiling, I start to cry. I cry, I cry, I say that I want to die, that I know very well that it’s not their job to kill me, but I beg them to do it anyway. Finally, in response to my moans and my begging that they kill me, or failing that, that they at least turn off my mind, that’s what they do, and quickly. One shot, the fuses blow, everyone’s gone. Then begins a blank that lasts several days and would end this chapter if I didn’t have one more sentence to add. What I’m saying here is brutal, but my condition was brutal and I’d like it to be clear that the doctors I dealt with at Sainte-Anne were and are all very competent, but hey, there are jerks everywhere, and as things turned out, there was one who called Nathalie after this episode and asked: “Your brother has made a request for euthanasia, what do we do?”
* * *
The psychiatrist who treats me has seen a lot of melancholic depressives in his time. He knows how to assess the risk of suicide, which he considered to be very high in my case, and I myself realise on rereading these pages that I can find no words to adequately convey the “intolerable moral suffering” mentioned in my medical report. If I can find no words, it’s because I’m too distant and detached today to be able to remember, describe or name the horror in which I was then immersed, and above all, I think, because there are no words for it. What I’m saying here sounds horrible, but in fact it was much more horrible than that. It was an unspeakable, indescribable, unqualifiable and – the word hardly exists, but no matter – immemorable horror. When you’re no longer there, you can no longer remember that – thank goodness. Would I have made it through without ECT (electroconvulsive therapy)? How would I have fared? I don’t know, and I’ll never know. But yes, maybe the ECT did save my life. But whatever the case, the improvement wasn’t spectacular. All during the treatment, my hospital report speaks of “non-linear development with moments of thymic improvement, without a clear recovery of vitality”, “significant thymic decline with anxiety and negative thoughts” and “increasing memory problems”.
In my experience, these memory lapses are the major – and most serious – side-effect of ECT. You’re told that they’re temporary, that your memory will come back, that at most the loss will only last as long as the treatment period, but it’s not true. I’m writing these words three years after the fact, and my memory is still a field of ruins.
It often happens to me that I talk to a friend without remembering what we said the day before, or even that we spoke the day before. I’m constantly afraid that the people I love will think I’m either neglectful or inattentive, or that I have the beginnings of Alzheimer’s – which wouldn’t be unlikely, because the risk of Alzheimer’s is much higher than average among people with bipolar disorder. There is, however, a silver lining to all this, because if memory loss is the collateral damage of electroshocks, they also had a totally unexpected collateral benefit.
One day, in the cafeteria of SainteAnne where he’d come to join me for a hot chocolate, I complained about these memory problems to my friend Olivier Rubinstein. He said: “You should memorise poetry, that’ll take the rust off your neurons.” And in this horribly difficult time, it made my life more bearable.
* * *
I’m discharged from Sainte-Anne at the end of April, and the report ends with this observation: “Good transient recovery but frequent relapses.” The fact is that for at least three months I’ve been doing better, much better even. The medication seems to be working.
Lithium is an alkali metal, an element in the periodic table, and, when administered as lithium salt, has proved surprisingly effective in treating mood disorders since the 1970s. I take it every day now, and when I take it I think of the melancholy reflection by the American poet Robert Lowell, who suffered from manic depressive psychosis in its most acute form until he started taking it:
“It’s terrible to think that all I’ve suffered, and all the suffering I’ve caused, might have arisen from the lack of a little salt in my brain, and that if the effects of that salt had been known earlier, if I’d been given it earlier, I might have had a happy or at least a normal life, instead of this long nightmare.”
I wouldn’t say anything so radical, because even though I sometimes think it was, my life hasn’t been one long nightmare. Still, I too belong to the group of bipolar patients who respond well to lithium. It makes my highs less high, my lows less low, and I’m so afraid to find myself once again back at the Sainte-Anne psychiatric hospital that I’m ready to take it, obediently, for the rest of my life.
This is an edited extract from Yoga by Emmanuel Carrère, translated into English by John Lambert. Published by Jonathan Cape on 2 June.
• In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.
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