Confessions of a Dangerous
Mind
He controlled a $375m business empire but he couldn't control his mind.
The story of one man's journey through the black hole of bipolar disorder.
By
Creed C. O'Hanlon.
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"What the hell are you looking at?"
-
"Does it bother you?"
-
"Yeah, it does."
-
"I'm sorry."
-
"You think you're going to get to know me, but
you won't."
-
"I'm willing to try."
-
"I'm not anything like you think."
-
"I don't think anything. Why don't you tell me
what you're
like?"
-
"Tell you what? I don't know. Why are we even
talking?"
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"I want to see how I can help."
-
"I don't need help. I'm just tired. I don't
want to think."
Listening to a recording of an early encounter with the psychiatrist who
would finally help me to gain control of my
mental illness,
it is hard to recognise the low, robotic snarl that is my own voice. Each word
abrades with a drug-compressed anger and there is an agitated physicality about
them that even now is frightening. I am, quite literally, bouncing off the
walls.
It was April 2000. I was 45 and had just resigned as a director of the listed
internet company I had co-founded and its board, caught wrong-footed by my
sudden departure – they had hoped to engineer it on their own terms – was busy
concocting responses to enquiries from a press that sniffed scandal. There was
plenty of lurid fodder. I was threatened with a suit for sexual harassment, and
several employees, at least one director, a co-founder, a former mistress and a
relative would speak on and off the record (mostly off) to reporters about my
personal and professional excesses. These ranged from violent mood swings,
fearsome bouts of abuse directed at staff, and periods of dark, incommunicative
withdrawal, to my abandonment of a wife of 10 years for a tumultuous
relationship with a married woman half my age and a financial recklessness that
had me tap-dancing on the edge of bankruptcy despite a generous salary package
and tens of millions of shares.
Many of the worst stories were true. I didn't bother to defend myself, even
when the board's chairman tried to disavow any knowledge of my having a history
of mental illness, even though it was noted in clippings contained in the
company's own press kits. Instead, I was reclaimed, if not forgiven, by the
family I had left a year before and together we fled to a large house outside
Tulsa, Oklahoma, my half-Cherokee wife's birthplace, as far away as we could get
from the wave of media attention, not to mention the financial and legal woes,
that almost devoured us.
At first glance, Tulsa was an unlikely refuge. Once the oil capital of the
United States, the city had shifted its entrepreneurial focus from natural
resources to religion – Tulsa is known as "the buckle" of the Bible belt that
threads south of the old Mason-Dixon line – and health care when the Oklahoman
fields dried up in the 1970s. Today, there are as many medical practices and
hospitals as there are makeshift churches and, perhaps not surprisingly, given
Tulsa's growing population of charismatics and their born-again disciples, it
has attracted scores of talented young psychiatrists and psychologists, several
to Oklahoma University's psychiatry department.
But I was not aware of any of this when I first found myself sitting in the
waiting room of the department's outpatients unit. I was aware of very little. I
was deep within the throes of
fast-cycling episodes of mania and depression that had already been
diagnosed with deceptive precision as
Bipolar I Affective Disorder (Mixed). I
was unmedicated – and unarguably mad.
The term "manic depression" – like the word "mad" – is becoming
anachronistic. It has the whiff of 19th-century bedlams and over-romanticised
Byronesque excess. Besides, it is too often confused with uni-polar depression
with which it shares – during its "down" cycles – the same symptoms of
persistent melancholia, indifference to oneself and one's surroundings,
significant changes in appetite or body weight, difficulty sleeping or
oversleeping, loss of energy, feelings of worthlessness or inappropriate guilt,
difficulty thinking or concentrating, and recurrent thoughts of death or
suicide.
As its name implies, manic depression or bipolar affective disorder has an
opposite and seductively corrosive upside which includes, among other things,
persistent, abnormal exhilaration – or, paradoxically, irritability and violence
– reinforced by over-inflated, occasionally messianic self-esteem, decreased
need for sleep, increased talkativeness (often as a release for racing
thoughts), distractability, physical agitation or an inability to settle even
for short periods, and excessive immersion in risky behaviour ranging from
sexual promiscuity and self-endangering stunts to gambling and spendthrift
shopping sprees.
The Diagnostic and Statistical Manual IV, the US psychiatric "bible",
describes the three main sub-sets of the disorder as, Bipolar I, in which one
has experienced at least one manic episode and depression, as well as, possibly,
psychotic symptoms; Bipolar II, in which one has experienced moderate mania, or
hypomania, but has not experienced
psychotic symptoms; and Cyclothymia, a milder form of bipolar disorder, in
which the cycles of depression and hypomania are shorter, irregular and less
intense, with episodes lasting for days rather than weeks.
The alternation of depression and mania usually occurs over several months
but it can also be rapid cycling, which is specified by the American National
Institute of Mental Health as four or more incidents of illness within a year.
Worse, there can be mixed symptoms in which mania and depression are
simultaneous: for example, a depressed, suicidal mood exacerbated by
sleeplessness, agitation and racing thoughts. In the most severe cases of
Bipolar I, periods of psychosis are marked by hallucinations (seeing, hearing or
sensing things that are not present) or delusions (false, fixed beliefs that fly
in the face of reason or contradictory evidence and are not explained by a
person's usual cultural concepts).
A diagnosis of bipolar affective disorder can be hard to pin down, not
because the mania is latent or unrecognisable – quite the opposite – but because
a patient will most often seek help during the debilitating, depressive phase of
the illness, when it is indistinguishable from uni-polar depression, rather than
during the elated, edgy, manic phase. Psychiatric diagnoses are always reliant,
in part, on the openness of the patient, and while some patients find it
relatively easy to talk about the general symptoms – if not the causes – of
depression, it is not the same with mania. Patients can fool themselves into
thinking there is nothing to talk about: the highs of mania often feel so good,
whereas the lows of depression never do. They can also be unwilling to expose
their more ruinous manic symptoms – violence, sexual addiction, infidelity,
gambling or profligate spending – because they are ashamed or they fear their
doctor's reprobation or they derive a perverse sense of fun from keeping their
unruly dramas secret. In many cases, doctors just don't see it.
Some 2% of Australians suffer a bipolar affective disorder; 20% of those with
Bipolar I will die by suicide. Despite its current, transient allure as the
illness of the moment – the result, perhaps, of its tantalising glimmer of
careless self-negation – there is nothing glamorous about the disorder. More
than any other mental illness, it is a black hole of neurobiological, chemical
and emotional disarray with a capacity to destroy everyone and everything that
strays into its swirling maw. And, unlike an addiction, there is no choice about
whether you have it or not. It's genetic, not neurotic, the bad luck of some
natural draw.
I was eight when I had my first manic episode, a fit of inexplicable rage at
the end of a normal day at school that could only be subdued by the attendance
of the family doctor and an injection of a sedative. For several weeks
afterwards, I was nervous, unfocused and kept complaining of "these things in my
head that won't stop". I had always been sensitive to loud noises but now I
heard otherworldly sounds and voices within those noises. I didn't tell anyone
about them. I also didn't tell anyone I felt like something was different inside
me, as if my body had been possessed by an unfamiliar anima.
Over the next few years, a new me did emerge. The young boy who did well in
class, who had an IQ of 141, who captained the winning house in sports during
his final year at primary school, became a disruptive, failing high-school
student. I passed through half-a-dozen schools, attending fewer and fewer
classes as teachers threw up their hands at my lack of interest in learning and
my increasing delinquency. I grew more solitary, introspective and angry in
each.
At home, I was worse. Conflicts with my parents were fraught by an
ever-present threat of violence that, by the time I had reached my early teens,
had become intolerable for all the members of the family. I refused to
co-operate with their attempts to get me help. Unusually for a young adult with
the disorder, I didn't try to self-medicate with alcohol or drugs – for 40 years
an unlikely instinct for survival has steered me away from all substances that
might topple me into psychosis – but I thought nothing of stealing money or
running away to spend the night with a girlfriend and, if obstructed, usually by
my father, pulling a knife to intimidate.
I left home when I was still a teenager, abandoning the prospect of a
tertiary education. For a decade, as relentless and often simultaneous cycles of
extreme highs and incapacitating lows laid waste to my attempts to start, let
along sustain, something approximating a normal life, my parents would allow me
to return to recover, albeit with a mixture of caution and dread, then lend me
their support to start again. But this was just the beginning of a long and
devastating siege, not just for me but for my family and (by now) few friends.
At 25, I assaulted a person with whom I was sharing an apartment in London
during yet another manic rage and was forced to surrender myself to a
psychiatrist. In his reference to the clinic to which he recommended I be
committed, he wrote:
"My impression is that he is a very depressed individual who has a great deal
of difficulty dealing with negative emotions, specifically rage. He is an action
person who 'acts out' and therefore avoids feeling.
"His development seems to have been marred by a lack of structure so that at
times he is unable to be self-disciplined. There also seems to be an intense
need to flirt with death."
That opinion, formed during a single, prolonged session during which I said
nothing, was the basis of my treatment as a sufferer of uni-polar depression
(and my temporary commitment), despite inferences in the two short paragraphs
that there might be much more to my illness than that. For another 17 years,
through two stays in mental health facilities in Britain and Australia that were
more protective than curative, the treatment persisted. No one noticed that the
variety of medications prescribed to alleviate my depression actually elevated
my mood way above any median line of "normal". Borne aloft by mania, I would
stop taking the drugs (which were, as it turned out, inappropriate and even
dangerous for my real condition) and cancel my regular appointment with
whichever psychiatrist was caring for me at the time: I am happy, I thought, so
I must be well.
It was a physician in Los Angeles, an experienced GP rather than a
psychiatrist, who recognised that the diagnosis of uni-polar depression was
wrong. Treating me for sciatica over a few weeks, he observed the acute mood
swings, the jittery inability to settle and the extended, rambling monologues of
elevated mania, as well as an episode of almost fugue-like listlessness. He
asked me to discuss my previous mental health and its treatment with him, and to
describe my behaviour when I was off medication and not seeing a psychiatrist.
Two hours later, I was with a psychiatrist at the University of California,
LA, who, after a few more sessions , agreed with my physician that I was
bipolar. He prescribed 500mg a day of a drug called
Depakote, a
proprietary form of sodium valproate (marketed in Australia as Epilim), an anti-convulsant
which has proved more successful than
lithium in controlling
mania among many patients with Bipolar I. He also insisted I discontinue the
antidepressant Zoloft prescribed by a previous psychiatrist. We agreed to
schedule regular bi-weekly sessions for him to monitor the effect of the new
drug and possibly introduce some others, such as Lamictil or
Lexapro, to control my
depression and modify an increasing obsessive-compulsiveness and some unusual
phobic effects (among them, a 20-year refusal to dine at other people's homes).
I never filled the prescription and I never saw that psychiatrist again.
A couple of years ago, in a Nike store in Tokyo, I came across a pair of the
most comfortable shoes I have ever worn. Somewhere between a rubber-soled
slipper and a water-sock, the porous nylon slip-ons were so snug and light that
walking in them felt like skipping barefoot on air. I had to buy them.
On my way to the counter, I was gripped by a mild panic. What if the shoes
wore out and I couldn't replace them? What if the shoes were only distributed in
Japan and I wasn't able to find them elsewhere? I asked the shop assistant in
halting Japanese if there was another pair in my size in stock. There was. I
said I would buy them too.
But the panic wouldn't subside. I asked the shop assistant how many other
pairs in my size were in stock. He checked the storeroom: three in black, three
in red, one in orange. I told him I would take them all. By the time he had
returned with the boxes, I had decided I should make sure I had enough to last
for a couple of years. I asked the shop assistant to check the stock in other
Nike stores in the city, as well as the main warehouse. For good measure, I
asked him for a few pairs in my wife's and my mother's sizes.
Within half an hour, I had bought 87 pairs in three different colours, at
about $35 each, for a total of just over $3000. I arranged for them to be
couriered to my home in Tulsa (for an additional cost), where they still gather
dust in three large wicker baskets.
It is hard to describe the curious conflict of uncertainty and excitement
that marks these impulses, but it is typical of manic behaviour. When I was
being deposed by my first wife's lawyers in the course of a suit for divorce,
her lawyer focused on my high expenditure on gifts, which, she argued, were most
likely for young women. But it was not that simple: my own lawyer demonstrated
that I spent money on everyone, male and female, even people I didn't know, for
reasons I couldn't really justify other than it satisfied a momentary need
which, had I ignored it, would have driven me to maddening distraction.
Ah, madness. At times, it is almost as if, consciously or not, one is driven
to unleash it and give it free rein. Little wonder then that, throughout
history, manic depressives have excelled in the arts and entertainment, from
Dante, Michelangelo, Caravaggio, van Gogh, Dylan Thomas, F. Scott Fitzgerald,
James Dean, John Huston and Jackson Pollock to Brian Wilson of the Beach Boys,
Spike Milligan, Robin Williams, Robert Downey jnr, Carrie Fisher, the directors
Francis Ford Coppola and Tim Burton, and media magnate Ted Turner.
One of the pioneers in the use of lithium to treat bipolar affective
disorders, Dr Ronald Fieve, has even argued the energy and inflated confidence
that are typical of the disorder's highs creates what he calls "a hypomanic
advantage" that enables some sufferers to "rise to greater heights" than those
who lack this inner drive, and to excite those around them. There is no question
that in many cases, my own included, there are periods of expanded consciousness
and limitless energy in which one is able to multi-task to an extraordinary
degree, processing multiple, simultaneous streams of data in a way that is
unimaginable among normal people and solving problems with unusual speed. There
are also the almost extra-sensory, instinctive episodes that verge on apophenia
– the spontaneous perception of connections and meaningfulness of unrelated
phenomena – that might lie at the root of why so many manic depressives excel in
science.
But there are three dirty little secrets all sufferers of a serious bipolar
affective disorder share. First, we have a strange, self-destructive love of our
madness that makes us unwilling to surrender it to treatment; instead, we find
every excuse not to take the medications that, if they can't eradicate, can at
least relieve its worst effects. Second, we love the rush of mania – love the
sudden pituitary flood, the caustic buzz of chemical imbalance – that is as
addictive as a first hit of high-quality crack (and, unlike crack, the rush gets
better, albeit riskier, every time). The third is that, whenever we are dragged
down by the cold, grim undertow of depression, there is rarely a moment in which
we are not contemplating death.
Even an accurate diagnosis and the best medical care can't guarantee the
stability of the disorder. A year after I had begun treatment at Oklahoma
University, where I had been undergoing twice-weekly therapy sessions and weekly
reviews by both a resident psychiatrist and the head of the department, the
latter to refine the medications and to monitor their effect, I was out of
control again. I had accepted a job in Japan and, tethered neither to my family
nor to the group of doctors who were treating me and commuting 30,000km a month,
I became tired, less mindful of my treatment and prone to escape into the
behavioural patterns that had torn my life apart a few years before.
This time, threatened with the irretrievable loss of my family, I drew back
from the edge. I resumed my medication – now 2500mg of slow-release Depakote a
day to control my mania, 20mg of the antidepressant Lexapro, and up to a
milligram of Clonazepam a day to control my sporadic anxieties – and the doses
are now the daily sacraments that affirm my commitment to sanity.
My battle with the disorder continues to be part of the everyday of my
family. There are still confounding moments when it subverts the medication or
overruns its modest defences to assail me with despair or buzzing, obsessive
restlessness. The disorder gets worse as I get older. I am becoming more and
more intolerant of its endless, wearisome cycle: when I am low, the longing to
end it is always close by, like some dark angel offering to enfold me within its
wings.
It doesn't help that recent, prolonged periods of wellness have brought
disconcerting revelations. A year-and-a-half ago, I began to experience what I
described later to my psychiatrist as momentary flashes of an alternative
reality, as if layers of memory had been peeled back by the reconfigured
chemistry in my system to allow me clearer glimpses of my past. Except it was
not a past that was familiar. There was something so hallucinatory about it that
for a while, I was scared to acknowledge it, let alone investigate the
discrepancies. When I finally did, it became apparent my psyche was littered
with delusions and inventions. Some were being dissolved by the medication but
not enough of them, and I was faced with a disturbing, disjointed mystery of who
I really was, when, where, and with whom.
Today, there are memories I have I know are real and there are those I
suspect or know are not. Then there are the nulls, the unrecoverable blank
spots, as dark and impenetrable as the dead screen of a TV. I hear from others
about something I said or did in the past and I have no recollection of it at
all: it's as if they are talking about a stranger. I am gripped by a need to
reach back into my past and salvage whatever fragments of my memories I can
find. But it's a flawed ambition: so much wreckage, physical and emotional, is
strewn across nearly half a century that, like a crashed plane reassembled by
forensic investigators in the hopes of figuring out what happened to it,
whatever I come up with can only be a skeletal approximation of the real thing.
Yet the process of recovering as much as I can from my disordered psyche, of
bringing some coherence to the details, of being convinced that what I remember
is real rather than imagined or invented, still feels urgent. Perhaps it is
because, without memories I can rely on, I am disenfranchised from my true self,
and the experiences and perceptions that have shaped my connection to the
present feel meaningless. All I am is my disorder. That thought alone is enough
to drive anyone mad.
Creed C. O'Hanlon was a co-founder and former CEO of Spike Networks. He
retired from the world of business in 2003 to write full-time.
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