Hello insomnia, my old friend...

I know I am becoming unwell. Maybe “becoming” is an overstatement. It implies a kind of inevitability that I will descend into madness. That is not inevitable, but I have symptoms. Items on my carefully constructed “symptom list” have started to flag up.

The whole point of the list was to catch my mood disturbance before it spiralled out of control. To find a way to surf the waves rather than have them drag me under. So why am I not doing anything about it? I had a couple of weeks where anxious/low type symptoms were present. Nothing pathological, and nothing I couldn't do something about. In fact, I'd say my mood has pretty much been “normal” for a good month until now.

Now I am restless. Now I am avoiding sleep. There is so much to do with the day, oh how I wish a day had more hours than it did. I want to do everything: to learn, to teach, to sit exams, to practice medicine – oh, how I love being with patients! - to drive, to drink, to cook and eat, see friends, go to the beach, go to the gym, shop (especially for expensive dresses), to charm, to smile, to feel happy - why can I not be happy? Why do they (mental health professionals) want to curtail my excitement? I hate them. I loathe them, no, not just them, I loathe everyone. They're liars. This isn't a diagnosis, this is me and I am happy. I don't need to sleep – they're wrong.

Why am I so fixated about what they would think if they saw me now? Because in my heart I know something is wrong. I know they would worry about me sleeping less, about the times my thoughts rush, about me dropping almost £200 on a dress I really didn't need on Saturday because I felt like it (“I'm a doctor, I'm rich! I can have anything I want!”).

It's not all fun and games. A part of my heart is intermittently sinking. I am hearing those niggling voices say, “she hung herself”, “she hung herself”, “she locked herself in her room and hung herself”. Not one suicidal thought for two months and now they're back again. Damn those pesky voices...

What to do? My action plan involves stopping drinking and going to bed on time. Well, it's way past midnight already, and I resent trying to sleep when I don't want to. I didn't have a drink tonight, but it's a school night. Come the weekend I'll have forgotten this pledge to myself.

Who to tell? I've told my boyfriend, but he's gone abroad for a fortnight. I have a new GP I'm seeing on Friday. New. Can I trust him? Can I trust him to understand this, to understand me? I have one more session of CBT pending. Let's hope I can use it to turn myself around again. Because I am lost for ideas and lacking motivation.

It's hard to want to change when you're enjoying yourself.   

Perfectionism

I've been going for CBT for three weeks now, and I have to say that day by day I am getting better at challenging my negative thoughts. Whether that is due to the CBT, medication or other factors such as being back at work I will never know.

Keeping my little thought diary has shown me how desperate I am to please others and how much I fear criticism or punishment. Yesterday my therapist pointed out that this tendency has its benefits. It drove me to succeed through A-levels and medical school. I have managed to command a lot of respect over the years from people around me. I've won prizes. I have a great CV. But then there's the flip side. The moment when failing to achieve my goals becomes intolerable to me and I give up altogether. Many people with depression and bipolar disorder are very talented and successful when well. Is this why? Are talented people prone to depression when the praise dries up?

I've received so much praise in my life. From the age of five I was reading and writing better than anyone in my class. I was way ahead when it came to maths and languages. OK, so sport was never my strong point, but you can't have everything. The point is – I was constantly told I was clever by both teachers and a pair of loving parents. So when I moved to a bigger school with pupils as clever as me it was a shock. I managed to get over it and climb my way back up the academic ladder. Yet by the time I hit medical school I was definitely mediocre. Indeed, in my current friendship circles I still am mediocre.

My default mindset seems to be that I am a) stupid, b) fat, and c) unpopular. Luckily this mindset tends to be challenged on a daily basis unknowingly by others. I might get good feedback from a senior doctor; I might squeeze in to a small dress and note the fact that my BMI is only 21; I might find myself surrounded by friends and having a good time. When I am well I can get away with the odd reminder that I'm not as bad as I think I am. But when I am unwell I need constant praise and signals from others to stop me from sinking... And life's just not like that is it?  

Dreaming of aubergines...

I'm beginning to think that being a doctor could be a bonus when it comes to accessing treatment for bipolar disorder (once you are able to get over the trauma of temporarily being a patient, not a doctor). On this occasion I seem to have been fast-tracked through the system. Appointment slots have miraculously appeared for me. My GP made it very clear that I was a doctor during the whole referral process... As a result I got myself onto a CBT programme within a fortnight. Whether it will help God knows, but I've never known the NHS to act so quickly in response to mental illness. I'm being treated almost as well as a cancer patient!

In other news, I've just woken from an extremely vivid dream about giving a presentation at the UK's “National Aubergine Conference”. Nice. An hour before I was lying in bed weeping. I haven't been able to leave the house all day. I checked my email and made myself a fantastic lunch (surprise, surprise), but then froze and started to cry endlessly, mainly worrying about my career. Checking out the aubergines at this conference was a real mood booster though. When I woke up I had all but forgotten my woes and had set my mind to thinking about what I could next cook with an aubergine (when I've thought of something I'll let you know). Is that the sort of experience I need to be talking to my psychiatrist about?

When the other half gets home we've planned to cook another recipe from the Kitchen Shrink - grilled trout and toasted sunflower seeds with leeks. Supposedly the fish oils will do me no end of good. Don't get me wrong, I love fish, but sometimes the thought of deliberately cooking something healthy just makes me crave pizza. And not thin, upmarket pizza. Thick, greasy, cheap, pan-friend pizza of the Pizza Hut variety. With lots of meat. Meat and aubergines.