Life after Darkness
A doctor who underwent psychosurgery has written a book about her experience. After being admitted to hospital several times for depression and undergoing more than 100 electroconvulsive treatments, Cathy Wield had an operation in Dundee, Scotland, and now feels she has been cured of depression. The following article is from The Daily Telegraph, 23 January 2006
'I decided to overdose, slowly'
(Filed: 23/01/2006)
"When nothing could treat her depression, Cathy Wield agreed to brain surgery
It was 1994, I was a junior doctor working in A&E. My husband, Phil, and I had swapped roles, so that I could pursue my career, and he was looking after our four children, an arrangement that we were all happy with.
I admit that my life was far from typical: there were many unusual features to it, but none that could predict the onset of the depression that was to begin that December. I cannot give an accurate picture of how it started, but it was like a mist coming down. A dark mist that clung to every part of my body and mind. I lived it and breathed it. I was off work, "sick", and the memories I have of that time are of long days spent in our bedroom doing very little.
Depression is more than a state of mind, and I felt very unwell. I was continuously tired, exhausted and lacking in energy. I wanted to sleep, but often sleep would not come. Every task was a great effort. Eating was a trial, as I had little appetite and I was constipated. I self-diagnosed, and was of the opinion that with medical assistance, it would soon be over. My GP prescribed medication and I received counselling.
That Christmas holds no memories for me, and as the New Year passed, I remained off work. The depression was gaining momentum. By February, I was desperately suicidal and was admitted to the Old Manor Hospital, Salisbury. I watched from the window as Phil drove away, tears rolling down my cheeks. I felt hopeless, guilty, ashamed and quite convinced that it was my fault.
By now, I had developed psychomotor retardation, when the processes in the brain are slowed, so, in addition to drug treatment, I was started on electro-convulsive therapy - a controversial procedure that applies a jolt of electricity to the head, to induce a seizure. It had some success, and, after six weeks, I was well enough to return home. But the improvement was short-lived, and, after as many weeks, I was re-admitted to hospital.
In the meantime, Phil was left at home with the children, knowing my sick pay would soon stop. He started to look for work, while juggling all the children's activities and wondering how he was going to cope.
A monotonous pattern was starting to emerge. Hospital admission with concomitant ECT was interspersed with periods at home. I was on several drugs, having regular psychotherapy, and, when I was at home, my community psychiatric nurse would visit twice a week.
I was not much of a mother, and Phil had effectively lost his wife. I was quiet and dispirited; nothing of my usual outgoing personality seemed to be left. However, I had not lost my intelligence - even though my thinking was slowed and delusional - and I decided that I had had enough of hospitals, and that my extreme misery was outweighing my desire to be at home with the children. Living had become a kind of hell. The only way out seemed to be suicide.
That September, once the children were back at school, I decided to overdose, slowly, on lithium, knowing that it would eventually poison and kill me. I thought this would go unnoticed. However, somehow, my psychiatric nurse got wind of it; Phil came home one day to find my GP, social worker and psychiatrist applying the Mental Health Act to detain me against my will for up to six months. The children were taken to a friend, and I was forced into the waiting ambulance; I wanted to run, but the ambulance crew dragged me back. I had become a prisoner, for my own good, for my own safety.
I arrived at the NHS psychiatric hospital, a dreary, run-down, understaffed institution. The furniture was old, and the carpet stained, but the physical surroundings were only part of the misery. Verbal aggression occurred on a daily basis, and I witnessed physical violence. Since the ward had very few private rooms, I soon found myself in a dormitory.
I craved privacy. The staff were clearly overstretched, and the nurses had little time to spend with patients. Being listened to was the only comfort I knew; it was the only painkiller for the agony of my mind, but, like any analgesic, it wears off. I required it regularly and frequently - something which could be delivered so easily in hospital, if only the nurses could find the time.
I started to inflict pain on myself: partly as a distraction from the torture of my mind, and partly as an obsessive punishment. I would get up in the night and pour boiling water over myself, and then lie in extreme pain. Two years, three years, four years - they merged into each other. By the time the fifth passed, I had been sectioned on several occasions. The doctors were doing their utmost to get me well enough to be at home, feeling it was important for the family to be together. However, despite the different combinations of drugs, I remained stuck in what, by then, was recognised as a chronic, treatment-resistant depression.
Finally, in 1999, Professor Chris Thompson, of the Mood Disorders Service at the Royal South Hants Hospital, suggested brain surgery. I felt as if I'd been struck by lightning, such was my surprise. I had never heard of an operation for depression, and I was scared. He described how, in an anterior cingulotomy, a discrete lesion could be placed, to interrupt the abnormal neural pathway that is thought to be responsible for this type of depression. I would be left with two very small scars on my scalp, a very small risk of fits and it might not work (as is the case for 33 per cent of patients) - but that was all.
Neurosurgery for mental disorders, he explained, is reserved for those patients with severe, life-threatening depression. In my case, it was predicted that I would either kill myself or die as a result of the self-harm. My most significant concern was whether it would affect my personality, but I was assured that the risks were extremely low. I was also worried that it would be done against my will, but it is never done without the patient's full consent.
By 2001, I was in a desperate way. Whatever the risks, I was living in torment and the only other option was death. I wanted this operation. Still on Section, I was transferred to the Ninewells Hospital, Dundee, for surgery - the only place in Britain where it was offered. [A similar form of psychosurgery, anterior capsulotomy, is done at the University Hospital of Wales in Cardiff - Sue K]
After the operation, I woke up with a turban on my head, and the worst headache I have ever had; I cannot recall anything else. For the first few weeks, I was not expected to do anything more than recover from the physical effects, but eight days later, the most remarkable thing happened: a light switched on in my head. It was as though the power cables had been connected, and, in an instant, my depressive symptoms lifted. It took several days before the ward staff were convinced that my experience was genuine. Phil came to visit me, and he knew immediately that he had his wife back.
I was still on Section, though, and was transferred to Southampton General Hospital. In the car, I cried at the prospect of having to stay in the hospital when I felt well; I realised, however, that to walk in with tear stains would not help my cause.
The following day, I met my psychiatrist. He was "flabbergasted" at the change he saw, and, within a short time, I was discharged from hospital. I almost danced out - such was my exhilaration and happiness.
Then came the reality of restoring my relationships with the children; I had missed seven years of their lives, they were so grown-up. I had not realised how hard it had been for my dedicated family, and Phil was exhausted. We had a turbulent year, but came through it in one piece. I returned to work in A&E, at Southampton General, which - since I had to face staff who had treated me as a patient - was a challenge.
It was then that I realised I needed to work against the stigma that mental illness brings. I hope that by publishing my diary of these years, understanding of this misunderstood illness will increase, and that conditions for patients suffering with mental illness will improve. I lost seven years to depression: seven years of being a prisoner - not just of my mind, but of a rundown healthcare system, which, according to the recent Mental Health Act Commission report, In Place of Fear, is still largely in existence."
Life After Darkness (Radcliffe Publishing) is available for £16.95, plus £1.25 p&p. To order, call Telegraph Books on 0870 428 4112
The first chapter of Cathy Wield’s book can be read here:
'I decided to overdose, slowly'
(Filed: 23/01/2006)
"When nothing could treat her depression, Cathy Wield agreed to brain surgery
It was 1994, I was a junior doctor working in A&E. My husband, Phil, and I had swapped roles, so that I could pursue my career, and he was looking after our four children, an arrangement that we were all happy with.
I admit that my life was far from typical: there were many unusual features to it, but none that could predict the onset of the depression that was to begin that December. I cannot give an accurate picture of how it started, but it was like a mist coming down. A dark mist that clung to every part of my body and mind. I lived it and breathed it. I was off work, "sick", and the memories I have of that time are of long days spent in our bedroom doing very little.
Depression is more than a state of mind, and I felt very unwell. I was continuously tired, exhausted and lacking in energy. I wanted to sleep, but often sleep would not come. Every task was a great effort. Eating was a trial, as I had little appetite and I was constipated. I self-diagnosed, and was of the opinion that with medical assistance, it would soon be over. My GP prescribed medication and I received counselling.
That Christmas holds no memories for me, and as the New Year passed, I remained off work. The depression was gaining momentum. By February, I was desperately suicidal and was admitted to the Old Manor Hospital, Salisbury. I watched from the window as Phil drove away, tears rolling down my cheeks. I felt hopeless, guilty, ashamed and quite convinced that it was my fault.
By now, I had developed psychomotor retardation, when the processes in the brain are slowed, so, in addition to drug treatment, I was started on electro-convulsive therapy - a controversial procedure that applies a jolt of electricity to the head, to induce a seizure. It had some success, and, after six weeks, I was well enough to return home. But the improvement was short-lived, and, after as many weeks, I was re-admitted to hospital.
In the meantime, Phil was left at home with the children, knowing my sick pay would soon stop. He started to look for work, while juggling all the children's activities and wondering how he was going to cope.
A monotonous pattern was starting to emerge. Hospital admission with concomitant ECT was interspersed with periods at home. I was on several drugs, having regular psychotherapy, and, when I was at home, my community psychiatric nurse would visit twice a week.
I was not much of a mother, and Phil had effectively lost his wife. I was quiet and dispirited; nothing of my usual outgoing personality seemed to be left. However, I had not lost my intelligence - even though my thinking was slowed and delusional - and I decided that I had had enough of hospitals, and that my extreme misery was outweighing my desire to be at home with the children. Living had become a kind of hell. The only way out seemed to be suicide.
That September, once the children were back at school, I decided to overdose, slowly, on lithium, knowing that it would eventually poison and kill me. I thought this would go unnoticed. However, somehow, my psychiatric nurse got wind of it; Phil came home one day to find my GP, social worker and psychiatrist applying the Mental Health Act to detain me against my will for up to six months. The children were taken to a friend, and I was forced into the waiting ambulance; I wanted to run, but the ambulance crew dragged me back. I had become a prisoner, for my own good, for my own safety.
I arrived at the NHS psychiatric hospital, a dreary, run-down, understaffed institution. The furniture was old, and the carpet stained, but the physical surroundings were only part of the misery. Verbal aggression occurred on a daily basis, and I witnessed physical violence. Since the ward had very few private rooms, I soon found myself in a dormitory.
I craved privacy. The staff were clearly overstretched, and the nurses had little time to spend with patients. Being listened to was the only comfort I knew; it was the only painkiller for the agony of my mind, but, like any analgesic, it wears off. I required it regularly and frequently - something which could be delivered so easily in hospital, if only the nurses could find the time.
I started to inflict pain on myself: partly as a distraction from the torture of my mind, and partly as an obsessive punishment. I would get up in the night and pour boiling water over myself, and then lie in extreme pain. Two years, three years, four years - they merged into each other. By the time the fifth passed, I had been sectioned on several occasions. The doctors were doing their utmost to get me well enough to be at home, feeling it was important for the family to be together. However, despite the different combinations of drugs, I remained stuck in what, by then, was recognised as a chronic, treatment-resistant depression.
Finally, in 1999, Professor Chris Thompson, of the Mood Disorders Service at the Royal South Hants Hospital, suggested brain surgery. I felt as if I'd been struck by lightning, such was my surprise. I had never heard of an operation for depression, and I was scared. He described how, in an anterior cingulotomy, a discrete lesion could be placed, to interrupt the abnormal neural pathway that is thought to be responsible for this type of depression. I would be left with two very small scars on my scalp, a very small risk of fits and it might not work (as is the case for 33 per cent of patients) - but that was all.
Neurosurgery for mental disorders, he explained, is reserved for those patients with severe, life-threatening depression. In my case, it was predicted that I would either kill myself or die as a result of the self-harm. My most significant concern was whether it would affect my personality, but I was assured that the risks were extremely low. I was also worried that it would be done against my will, but it is never done without the patient's full consent.
By 2001, I was in a desperate way. Whatever the risks, I was living in torment and the only other option was death. I wanted this operation. Still on Section, I was transferred to the Ninewells Hospital, Dundee, for surgery - the only place in Britain where it was offered. [A similar form of psychosurgery, anterior capsulotomy, is done at the University Hospital of Wales in Cardiff - Sue K]
After the operation, I woke up with a turban on my head, and the worst headache I have ever had; I cannot recall anything else. For the first few weeks, I was not expected to do anything more than recover from the physical effects, but eight days later, the most remarkable thing happened: a light switched on in my head. It was as though the power cables had been connected, and, in an instant, my depressive symptoms lifted. It took several days before the ward staff were convinced that my experience was genuine. Phil came to visit me, and he knew immediately that he had his wife back.
I was still on Section, though, and was transferred to Southampton General Hospital. In the car, I cried at the prospect of having to stay in the hospital when I felt well; I realised, however, that to walk in with tear stains would not help my cause.
The following day, I met my psychiatrist. He was "flabbergasted" at the change he saw, and, within a short time, I was discharged from hospital. I almost danced out - such was my exhilaration and happiness.
Then came the reality of restoring my relationships with the children; I had missed seven years of their lives, they were so grown-up. I had not realised how hard it had been for my dedicated family, and Phil was exhausted. We had a turbulent year, but came through it in one piece. I returned to work in A&E, at Southampton General, which - since I had to face staff who had treated me as a patient - was a challenge.
It was then that I realised I needed to work against the stigma that mental illness brings. I hope that by publishing my diary of these years, understanding of this misunderstood illness will increase, and that conditions for patients suffering with mental illness will improve. I lost seven years to depression: seven years of being a prisoner - not just of my mind, but of a rundown healthcare system, which, according to the recent Mental Health Act Commission report, In Place of Fear, is still largely in existence."
Life After Darkness (Radcliffe Publishing) is available for £16.95, plus £1.25 p&p. To order, call Telegraph Books on 0870 428 4112
The first chapter of Cathy Wield’s book can be read here:
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