It’s very difficult to get thorough mental health care here in London. The resources are stretched too thin. The only way to get lots of attention from an entire team of professionals is to remain an inpatient until one is well enough to leave the hospital. I was talking with Anita about this on Saturday, over Mother’s Day dinner out, when she insightfully asked: What would be “well enough”? I’ve put a bit of thought into that.
I have both anxiety and depression. (I’ve often wondered why they go hand in hand. Any thoughts?) I’ll divide my discussion that way
On the depression side of my symptoms, “well enough” would certainly require getting over my pressing suicidal ideations. Here inside the hospital, there aren’t what I’ve taken to calling “suicide affordances”, i.e., salient opportunities for killing oneself. As a result, I don’t think much about harming myself while I’m in here. But outside the hospital, there are suicide affordances galore. As an example, there’s a lovely bridge crossing our little Thames River which we walked over on Sunday. Unfortunately, the bridge immediately brought to mind the possibility of jumping off it. Until I can stand on a bridge without being aware of the opportunity it affords for suicide, I don’t think I’m ready.
In addition, before leaving hospital I’d like to have recovered an interest in activities that used to be entertaining, like reading fiction. I don’t expect to get back my ability to do work-writing any time soon – I am resigned to putting all of my energies into teaching and service instead, those being the other two components of my job as a professor. Nor can I expect to recover a life worth living, even though that’s the ultimate goal of treatment. But I’m still not interested enough in, say, reading a novel to exit the hospital.
On the anxiety side, I think I’m almost there in terms of “well enough”. The very good news is that the overarching fear, which used to just float freely in my consciousness with no apparent object, has subsided. On the other hand, I’m still very fidgety. I’m still restlessly crossing my legs. I’d like to be on something that controls the fidgeting better. And I’d certainly like to be well enough that I’m not afraid of going for a run. Maybe that’s another sine qua non of leaving the hospital, running being so important for my overall health.
Beyond the above, there’s also the issue of my physical health. My blood pressure keeps plummeting down into the seventies. I gather that’s really, really low because the nurses look at me funny – like I’m a walking corpse – when the machine shows that figure for systolic pressure. It’s likely the nortriptyline, the first-generation anti-depressant they tried me on, that is responsible. I am off it for the time being, until the team comes up with a plan. I think I need to be on an effective and safe anti-depressant before I leave my care team behind.