Half a century of bipolar disorder

More than 50 years ago, the NHS did a stellar job of supporting people with Bipolar Disorder. We must to get back to that.

Exclusive | 3 min read | Trigger warning: mentions of suicide and suicidal thoughts.

For information, help and support, visit mind.org. If you feel suicidal or need urgent help with your mental health, dial 999 now.

I do not want to write this account of what has happened to me. I do not wish to re-live the misery I have lived through. But if there is a chance my words might help someone else who becomes mentally ill, this is something I have to write.

These were the opening sentences of 'My Fight Against Fear,' an article written by my grandma, Eileen Herson, in 1971.

I’d come across the yellowed, typewritten pages whilst leafing through old boxes in my childhood home in the summer of 2020 and they’d offered a rare glimpse into a mind of a mysterious lady who had suffered from bipolar disorder and took her life the same year I was born.

Eileen’s word carry significance because my sister, Josephine, 24, and I have both inherited our grandma’s mental illness.

Sister Josephine, left, and Dorothy, right. Photo: Dorothy Herson

In early 2016, I started training at a London corporate law firm. Our offices were a vast, sprawling array of glimmering glass, Jaeger suits and a canteen which prided itself on opening every day - and night - of the year.

As trainees, we were told we were the brightest minds of a generation. Having attended a comprehensive school that closed in the early afternoon, the experience of now learning and working on ground-breaking deals until dawn felt euphoric.

Downhill

That is until the stress from the long hours and cutthroat culture of being a trainee lawyer in a prestigious and high-performing firm became a catalyst, triggering my disorder. Just 18 months into my training, I lapsed into episodes of mania and depression, oscillating between terrifying suicidal urges and hyper-activity.

Eileen Herson, who also had bipolar disorder. Photo: Dorothy Herson

I developed substance dependency issues as I desperately sought to numb the turmoil and pain in my mind. When I became too unwell to work, the firm, via my corporate health insurance, referred me to Harley Street, where I became a patient to one of the most prestigious psychiatrists in the UK.

On hearing my family history of bipolar disorder, it didn't take long for him to diagnose me with the condition in January 2018. Weeks later, I was admitted to a state of the art psychiatric hospital in West London where I tried different drugs, all of which failed to stabilise me.

Eventually, my psychiatrist put me on lithium, and it worked - the same way it had been effective for Eileen, who’d taken it more than half a century earlier. 

The difference was she’d received extensive, urgent and consistent support via the NHS. Were it not for my employer’s comprehensive private health insurance, I would have struggled to make any headway on the NHS myself.

I quit the legal profession in 2020, not only losing my belief that hard work and perseverance could elevate anyone to a decent standard of living, but also marking the end of my private healthcare.

Battle

I immediately began the long process of securing a referral to an NHS psychiatrist. After waiting for six months, I was told I didn't qualify as I wasn't at immediate risk of taking my own life. Of course, in the six months I’d waited, my mood had gone up as well as down.

A few months later however, whilst manic, I visited an abandoned mental asylum. The rotten floorboards collapsed beneath me and I fell a considerable distance through the floors, broke my spine and shattered almost every bone in my left foot in a near-fatal accident. 

As the injuries were so severe, I was told that I would be in chronic pain for the rest of my life, with limited use of my left foot. Feeling suicidal, I contacted the NHS again and begged for a referral. Finally, my physical injuries evoked enough concern for my mental well-being that I received four sessions with a psychiatrist.

A news report in February 2021 revealed access to - and the quality of - primary care and parts of community and mental health services have deteriorated in the UK.

It doesn’t surprise me. My sister has tried to gain psychiatric referrals since she was first diagnosed with bipolar six years ago, and has been met with countless rejections and cancellations. She’s finding it almost impossible to get the specialist help she requires and despite being on lithium, suffers from acute depressive episodes.

Sisters Dorothy and Josephine in happier times. Photo: Dorothy Herson

This is why bipolar disorder is one of many mental health conditions that requires constant monitoring, rather than one-off appointments or access to talking therapies and crisis teams when and if we are feeling suicidal. It’s especially important because our quality of life is severely compromised when it doesn’t need to be.

In my grandmother’s article, which I shared with my sister, it was a great surprise for us to read Eileen had been referred to an NHS psychiatrist within 48 hours of requesting one. That expert had diagnosed her with bipolar and confirmed in her medical records she ‘could not continue without psychiatric help.’

At last. After so many years of confusion and the strange feeling that I was in some way different from other people, somebody has understood - Eileen

My grandma also documented feeling ‘boosted by the incredible determination and strength of will’ of her general practitioner, who was ‘the corner-stone’ of her world, her friend and support in life, ‘able to talk me out of panic in a few cool, sensible words.’

Eileen recalls how the GP would visit her on nightly call-outs and work long into the evenings, repeatedly saving Eileen from the depths of her manic or depressive episodes.

Call-outs and this level of doctor-patient care have become a thing of the past. A GP packing up at 17:30 and spending the evening in a patient's home because of mental illness seems beyond imagination now.

Symptoms of mental disorders are seemingly tackled now on such an ad-hoc basis that many patients including my sister and I will never speak to the same GP twice, let alone receive follow-up calls, visitations, or above and beyond aid when in need.

Thorough

In contrast, upon meeting her psychiatrist, Eileen was immediately referred to weekly talks with a psychoanalyst, whom she describes as ‘a kind, deeply feeling, and sympathetic person’ to whom she would be ‘eternally grateful’.

Holly A. Swartz, M.D., at the University of Pottsburgh School of Medicine in Pennsylvania, confirms that psychotherapy, ‘when added to medication for the treatment of bipolar disorder, consistently shows advantages over medication alone.’

This is what my sister and I, as well as many other U.K. patients desperately need.

Dorothy. Photo: Dorothy Herson

But currently, the official maximum NHS waiting time for talking therapy is 18 weeks, yet this does not align with reality. Patients with depression and anxiety often have to wait 6-8 months for a session with a therapist. For less common, more severe disorders such as bipolar or schizophrenia, the British Medical Association has said the situation is far worse, with ‘increasing inequality between people suffering mild to moderate mental ill health and those with severe mental illness’.

For those suffering from severe disorders, the wait time can be years. Indeed, in six years, my sister and I have never, between the two of us, managed to secure an NHS session with a talking therapist.

Due to Covid-19, NHS resources are stretched beyond all capacity. Long-term Government cuts meanwhile have devastated the NHS, and mental health resources seem to be a low priority, to the point that, whilst suicidal, I have been asked by over-stretched care-workers to ‘hang on’.

Untenable

Waiting lists to see a therapist are over two years long, psychiatry appointments are reserved for those who are at ‘extreme immediate risk’ of taking their own life or another's. With almost no support, my sister and I cling on, living under the shadow of our Grandma's suicide, wondering if the same fate awaits us. 

What people like my sister and I need is sustained, regular, mental and medical help. Our disorder, as well as many others, are persistent and incurable, though with proper support and treatment, it can be better managed and hugely bolster our quality of life. Long waiting list and ad-hoc appointments via referrals are not suitable for this sort of illness, and the time referrals are taking can be dangerous.

Eileen made it to 1993, with exceptional support, before taking her own life at age 58. Exactly half a century later, how long do we, Britain's mentally ill, have left on our clocks?

• For information, help and support, visit mind.org. If you feel suicidal or need urgent help with your mental health, dial 999 now.

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