One year alive

Today marks a year since I tried to die.

It’s sunny and hot, which I appreciate after all the rain. I saw a crow taking a bath in some of the water left from the rain on a roof. I had a nice cold decaf coffee after work. Did some studying, did some knitting, had some lentils for dinner. Life gradually became normal. Mundane, in a good way. Not perfect but close.

I’m happy to be alive. Lucky, really. Forever grateful to the friend who managed to get me help in time.

I’m ashamed that I did it, ashamed of what I put people through, and ashamed of what I sometimes can’t help but see as weakness.

I’m angry at the system. Had I not nearly died, I wouldn’t have had any help. I would’ve died, if not on that day, soon after. It took two suicide attempts and getting hospitalised to get a diagnosis I could have gotten in the community two years earlier if a psychiatrist had paid attention to what I was describing.

I’m angry at the “you’re just not trying hard enough”, the “have you tried splashing your face with cold water? if you don’t try those things of course you’ll end up in A&E again”, the “maybe go to the beach, have some fish and chips, to me it just sounds like you’re stressed”, the “what you have cannot be treated”, the “you still haven’t tried to kill yourself so you’re not that bad”, the “think how lucky you are, how can you want to die when so many people have it so much worse”, the “no, I don’t think you have bipolar disorder”, the “it just doesn’t seem like we can help you.”

I’m angry not just at the individual people who don’t seem to be competent enough to work in the mental health field, but also at an underfunded and short staffed system where even the best of people often lack the time and resources to provide the best care.

I’m grateful to the hospital. I had a good psychiatrist who saw I had bipolar disorder right away and started me on medication, supportive nurses and healthcare assistants who made me feel safe and cared for, occupational therapy staff who helped me find coping skills that actually worked for me and got me participating in activities, and a psychologist who allowed me to see my resilience and good qualities instead of only seeing the moments where I was weak. It was all that help that enabled me to do the work to turn things around.

I choose to focus on the gratefulness and the appreciation of being alive. Anger and resentment won’t change the past, but I’m still disappointed at the state of mental health care.

How many people live feeling miserable, how many people die, only because they don’t get the help they need no matter how much they try to access it? How many people are made to feel as if it’s their own fault they’re like that, as if they’d be all good if they just tried harder?

I could be dead, and I’d be just another body adding to the statistics, another “what a shame, but what could we have done to prevent it?”

Listen to patients and service users. Treat us like the unique individuals we are. We’re not perfect textbook cases. If you give me a list of coping skills and I tell you they don’t work and I still feel suicidal day in and day out, perhaps consider the failure is on your part and not mine.

Life before diagnosis

Once I had a diagnosis of bipolar disorder and I achieved some mood stability, I went through a short period of mourning the past and the perceived loss of possibilities (the latter will be for a different post). It was short because I had already gone through that kind of process twice: first coming to terms with my estranged father’s suicide, and then coming to terms with being transgender.

I cannot compartmentalise my existence. There are things I did and didn’t experience because of being trans alone, or because of having bipolar disorder alone. However, most of my experiences are a muddy intersection of the two, with both also being influenced by the wider family and societal context.

Having said that, the years-long process of accepting the implications of being transgender was very much focused on that one aspect of my life. Similarly, coming to terms with my father’s suicide and my overall family situation is something I did in a very focused and also detached way. I was examining it the way one examines the plot of a movie. I was the viewer, somehow living through the storyline but not in it.

In retrospect and with the clarity of a diagnosis, I can see now that many of the things I went through internally were driven by my illness and not just life events or gender dysphoria on their own.

I got diagnosed with bipolar disorder last year at age 26 after hitting rock bottom. This will make up more than a quarter of my life if I make it to my 80s. At times it feels like wasted years.

My life before being diagnosed was characterised by long episodes of depression, hypomanic and mixed episodes, and short periods of euthymia.

During these short but stable periods, as an adult, I’d get a false sense of security thinking I wasn’t mentally ill at all. I’d convince myself things were fine and would only continue to improve. I told myself maybe things were never that bad to begin with.

It was only when a hypomanic episode arrived that I knew for sure I’d crash into depression again. When these episodes peaked, I can only describe the experience as descending into madness.

The peaceful periods in between episodes were filled with fear that they would never last. I was told this was pessimism. Some said my depression was my own fault because of this kind of thinking. I see now that it was a very realistic and accurate view, considering the very nature of this illness when untreated.

Of course, I didn’t have this bipolar-specific vocabulary of depressive and hypomanic episodes at the time. The fact that no one was diagnosing me with bipolar disorder despite my suspicions made me feel like I was just losing my mind. I eventually forgot about these suspicions.

I was never happy as a child. Gender dysphoria and a complicated family situation got in the way. I was rejected by peers, ignored or misunderstood by teachers, emotionally neglected by family.

I had my first suicidal thoughts when I was around 10, if not earlier.

As a teenager, the stable neutral periods were always obscured by life circumstances. They were different than the depressive episodes in that I didn’t feel such an overwhelming emptiness and despair, but I wasn’t happy either. I was unhappy in a ‘my life sucks’ kind of way.

For most of my teenage years I had suppressed all the gender-related feelings and thoughts I had as a child, so I was experiencing all the dysphoria without the conscious knowledge of what it was or where it was coming from. My body was uncomfortable to live in, to say the least. I started reading about astral projection; the idea of existing as a being with no physical form was freeing.

Family life was difficult for a variety of reasons since I was a child. Outside of home, most of my peers’ reactions to me ranged from harmless but clear disinterest to straight up bullying. This left me having only a couple of friends who, despite also being outcasts to an extent, weren’t as ostracized as me and eventually drifted away into broader groups of friends.

Ultimately, no one around me seemed to be going through the same turmoil I was going through, and no one showed any meaningful understanding. I found community online instead.

I spent most of my teenage years muddling my way through long depressive episodes on my own. I didn’t understand the odd periods where I felt confident, full of energy and on top of the world. I didn’t understand them because they never lasted, and because it wasn’t actual happiness given the everpresent gender dysphoria.

I continued to have passive suicidal thoughts and eventually started making plans at the age of 14, when my father completed suicide. I started self-harming soon after.

I dropped out of high school at 16. I was a good student, but my depression made it impossible to study anymore and I didn’t see the point in it regardless. My mother agreed this was best for my mental health, but offered me no help or support. In fact, she later confessed that when I was 15 she seriously considered offering to kill me to put me out of my misery.

From that age I had no friends until I started finding some community online. The few in-person friendships I had ended in part because of my mental health issues. I isolated myself. I had no idea what was wrong with me.

In the next couple of years I realised and accepted I was transgender and needed to medically transition. The perception I had of myself as a child and the relationship I had with my own body finally made sense. I began my social transition when I told my family at 18. This gave me a glimpse of hope that at least that part of my pain could get better. Despite the hope, I felt deeply ashamed of being transgender.

I returned to school when I was 20, this time in a different city only being seen and known as male. This made things easier, but I lacked all social skills and suffered through social anxiety. I hadn’t really interacted with anyone in person outside my family or doctors for four years at this point.

That first year of school went smoothly, but on the second and last year of the programme the depression hit again and I nearly ruined my chances at a scholarship abroad. I managed to make that happen.

I had an apparently bright future ahead of me, my life was only getting better as my dysphoria diminished and my living situation improved by moving to a different country. And yet, my mental health was only deteriorating more and more. This made me very frustrated. Why couldn’t I be happy when things were seemingly only getting better?

I felt lost, disoriented, helpless.

Sometimes the break in between depressive episodes would allow me to recover, but in the last few years I was so worn down it was impossible to recover. Each episode was harder than the last.

On the other hand, the hypomanic episodes made me look happy and full of energy and optimism on the outside. Inside, it was a very different experience. As an episode progressed I had less and less control. The restlessness was endless. I channelled some of that energy into my work, but sooner or later the racing thoughts and irritability would take over.

I was impulsive, talkative, oversharing. I started dating soon after moving to a new country and engaged in risky behaviours. I decided I’d start running again, setting unrealistic goals and injuring myself. I planned a holiday I didn’t have the money for, which I cancelled as the depression returned. I spent money very irresponsibly. I enrolled in university, which I gave up on within a month of starting as depression hit again.

In these episodes I didn’t feel as happy as I appeared. I felt restless, irritable, out of control.

The last mood episode I had was a mixed one. Miserable, empty, numb, restless, racing thoughts I couldn’t keep up with, anxious, angry. I felt like I was losing my mind.

At one point I truly believed my real body was in a coma from my previous suicide attempt and this was all a dream. When talking about it, I kept saying “when I killed myself” insted of “when I tried to kill myself” because I really believed I had died. I then realised this wasn’t rational. But my mind was in such a perturbed, disturbing, incomprehensible state, that I saw death as the only end to it. I did think this was rational.

I went through with it and that’s when I ended up in a psychiatric hospital, where I finally got the right diagnosis.

I could’ve had a very different life. Not even going as far as the ideal scenario where I’m born cisgender and with no mental illness; just with things as they are but having had the appropriate help and support early enough. That would’ve made a massive difference. I could’ve lived and thrived rather than just barely surviving at all times.

At the end of the day, no amount of dwelling will change what my life has been. No amount of resenting those who could’ve but didn’t help me will change things.

I am now able to see my very young past self through the lens of compassion, rather than blaming him for what he went through and thinking he deserved it. This has played an important part in finding self-acceptance. Not only did I stop resenting those who didn’t help me or even made things worse long ago, I also stopped resenting myself for not being stronger.

It could’ve been better, could’ve been worse. But it was what was.