Madness (20 page)

‘So my carefully constructed hypothesis, that I'd remain well on the lowest possible dose of lithium, has been disproved,' I say to Winsome a week later. ‘Fuck it.'

‘Kate,' she says, ‘Surely it is clear now that you can't make these kinds of decisions about medication on your own. You must do so in partnership with a clinician.'

I sigh.

‘It's essential.'

‘How the hell do I find a psychiatrist who understands
primum non nocere
? The
Yellow Pages
?'

‘What about asking Jenny for a recommendation?'

I consider. ‘Okay. I can do that.'

Then I catch the train into work for a meeting with my manager. Though I've already arranged the next four weeks as annual leave, they'll add to the previous four weeks of leave without pay. Two months in total during which my colleagues are left to manage my workload as well as their own.

I can't face them. I'm gut-sick about it. I'm not well enough. Guilt. I'll never work again. I have to work again. Shame. It is impossible to be more unreliable. I love my work friends. I've let them down. It's an illness. Jesus.

Shame.

Diana, my manager is calm and realistic, and (oh-thank-you-universe) she doesn't sack me or suggest I resign. I tell her I'm struggling with a ‘mental health problem'. She ingests this quietly and doesn't pry. We develop a return to work plan. I apologise to my colleagues a thousand times and assist with the problems they've had while I've been away as best I can.

‘There is a difference between intellectually knowing something – and integrating, absorbing and owning it,' says Winsome the following week. ‘Does that make some sense?'

‘Yeah, it does.'

‘We both know you've had the intellectual knowledge about your illness for some time.'

I nod.

‘But you haven't owned it.'

I frown, wriggle my feet, look at the floor, out the window, back at the floor. Then I look at Winsome.

‘True,' I say.

‘And now?'

‘I think . . . I mean I know . . . I have a mental illness. And that my old, carefully constructed reality was, in fact, false – I mean, to the point of delusional.'

‘Yes.'

Suddenly here we are, me and it – the illness – face to face in Winsome's office. It's ugly, an unhealing wound. Blind and violent. I stare it down.

‘I accept that I'll have to take medication for the rest of my life.'

‘Because?'

‘If I stop taking it, I lose touch with reality. My thinking goes off, and then my behaviour goes off.'

‘What's the worst thing that could happen?'

‘Suicide obviously . . . and that I might hurt someone – hurt someone I love.'

‘And apart from medication?'

‘Taking responsibility. For all the bits of my life.' I pause and then smile. ‘Especially the dysfunctional bits, right?'

‘Yes,' Winsome smiles back.

Together we draw up a list of early warning signs, subtle changes in affect (mood), thinking, perception and behaviour.

‘What's the very first thing you notice?' Winsome asks.

‘Heightened sensitivity,' I say. ‘To sound – the loudness of someone's voice or the pitch of a musical note or a particular kind of sound; sometimes I can listen to an oboe but not a clarinet. And to light, especially dusk, and to temperature – hot water or cold wind. Later on any extremes of sound or sudden bright light are physically painful – like being hit with a taser.'

The medical journals and practice guidelines report that up to 70 per cent of people experience early warning signs over a period of one to four weeks prior to relapse into an acute illness like mania or severe depression or psychosis.

‘After that?' Winsome asks.

‘Sensitivity becomes intensity becomes . . . menacing. This inexplicable and pervasive dread.'

‘And then?'

‘The nightmares start and my sleep pattern changes and my mood changes – either melancholic or kind of elevated and buzzing. To combat all this, in the past, I'd start drinking a lot of whisky to anaesthetise myself.'

Some early warning signs are common among people with a particular illness but many are unique. A relapse signature is a list, usually time-dependent, of an individual's early warning signs.

‘Season change is risky for mood change,' I say. ‘Especially from summer to autumn – those cooler, shorter evenings, and from winter to spring – the warmer, longer evenings.'

‘Why?'

‘I don't know . . . maybe it's about light and melatonin. Maybe it's the idea of transition. Whatever the reason, it's a trigger.'

My relapse signature continues with irritability and restlessness or a weird heaviness in the chest. Sometimes concentration deteriorates.

‘Other times,' I say to Winsome, ‘it's like I've got two brains.'

‘This is when you must ask for help,' she says.

I nod. ‘Because obsessive thinking follows, and then strange preoccupations and chain smoking and suspiciousness. And I'm starting to lose insight – around the edges.'

Winsome writes everything down in red on her whiteboard so I can't hide from it.

‘What happens next?'

‘This is hard, to you know, to say out loud.'

We pause for a while.

‘Shit,' I say. ‘Okay . . . flight of ideas, visions, serious insomnia and neglect – neglect of the things that matter like family and my wonderful friends and work responsibilities and home and well, me.'

‘You know, Kate, the earlier we intervene the better, for reducing severity and shortening the duration of relapse. Yes?'

‘Yes.'

‘Okay. What next?'

‘The ends of the earth. Usually I'll stop eating but I'll be drinking a lot of scotch or vodka. All I can hear are command hallucinations, do this . . .'

Based on my relapse signature, we draw up an action plan in exactly the same way asthmatics and diabetics have an action plan. We talk about the importance of seeking help before I begin to lose insight and about reality testing. That is, checking in with someone I trust about obsessive thoughts. Or sudden new ideas. Or changes in mood that are unrelated to external events.

‘And medication?'

‘Hah! No self-medication. I'll make an appointment with Jenny.'

‘Do you trust Jenny?'

‘Yes.'

‘That's the most important thing,' Winsome says. Then she says, ‘You have ownership of this illness. You have ownership and control.'

I roll my eyes. ‘It's only taken me ten years of trying every kind of medication . . . and therapy.'

‘Now travel safely and keep well and we'll continue the discussion when you're back home.'

‘Be'seder. Merci, Madame.'

At 2 a.m. I take a taxi to the airport and board a flight to Paris. Thanks to the sedating effect of olanzapine, I sleep for the first half of the flight and then read till we land at Charles de Gaulle.

Rising up from the Metro. Heartbeat. Flush. Breath.

Here is the Jardin du Luxembourg on one side and on the other, ah – the beautiful buildings of the Sorbonne. Here perhaps, walked Sartre and de Beauvoir. I slide my backpack to the ground and sit on it. This is about experiencing the world as a newborn – free of the people in my head and the associated paranoia and magical thinking. Free to absorb the world exactly as it is.

My little hotel is in the Quartier Latin. I find a cafe near the Panthéon and drink coffee in the sunshine and people walking by half-smile at me or half-frown and I realise I'm grinning.

On Île de la Cité, amongst the buildings of the Palais de Justice is La Sainte Chapelle. The gothic ceiling of the lower chapel, a blue-heaven canopy, reaches down with generous gilt arms to support the floor. The upper third of the walls are stained glass and are beautiful – and whet the appetite. I climb the single flight of stairs.

Heartbeat. Flush. Breath.

There are no structural supports inside the chapel; nothing impedes my gaze no matter where I cast my eyes.

And nothing is in shadow.

The room is aflame. The current of light. The veins of colour. The enormous flowering. Here is a thing envisioned and created by a group of people 750 years ago that, I think, rivals the beauty of nature. It's a breath from alive. The stone floor is undulating, dimpled around the perimeter, so many feet.

I walk over to Île St Louis past the formidable walls of Notre-Dame, onto the right bank of the Seine and then into the Marais for an early bistro dinner.

‘Vous désirez?' asks the waiter.

‘Est-ce que vous avez une carte en Anglais?'

‘Non.'

‘Oh. Okay. Um . . .' The menu is hand-written. Finally I find a word I understand. ‘Steak tartare, s'il vous plaît.'

The waiter nods and smiles and ten minutes later I'm presented with a plate of chilled, finely chopped and seasoned raw steak, garnished with raw onion and a raw egg yolk. The waiter smiles again, and yes, I know exactly what he is thinking.

In the Musée D'Orsay are paintings by Klimt and Gauguin and Pissarro. This is pretty close to heaven. The queue out the front is long. I stand on one leg, swap to the other, look at the trees. People are chatting and laughing as they wait and suddenly I'm terribly alone. But once inside, the art up close is more astonishing than I'd imagined. In one room are thirteen paintings by Vincent Van Gogh, including a
Portrait de l'artiste
and
La nuit étoilée
. Oh, those very brush strokes!

With my last two days I visit the Musée Rodin for his bronze sculpture,
The Thinker
and Montmartre for the Espace Dali, whose work is, in his own words, an expression of ‘the associations and interpretations of delirious phenomena.' Mostly I'm reminded of psychosis, in the sense that I wonder if his interpretation of the world is bizarre enough to be impenetrable and unreachable by a majority of sane folk.

In the Marais district along rue de Thorigny is the elegant, aristocratic mansion, l'hôtel Salé, now home to the Musée Picasso. This artist catapults me out of myself, swings me around near the ceiling, flings me to the stars, steps on me hard, drags me through the blackness of hell and sets me weeping before the simplest line drawing.

The next morning I lug my backpack onto the train from Paris central to Charles de Gaulle airport. On the flight to Israel is a group of American evangelicals, all with bibles and nametags and hats. They're touring the Christian Holy Land in ten days – Sea of Galilee, Bethlehem, the Via Dolorosa, Church of the Holy Sepulchre and Gethsemane. The plane lands in Tel Aviv in the late afternoon and Naava is meeting me in the arrivals hall. The hall is huge, packed with family groups, kids with flowers and Israeli flags and black-suited, black-hatted Charedi men and I can't see her anywhere. The awareness that I miss her and I miss Zoë and my family hits suddenly in the guts. Eventually we find each other after an hour of wandering in circles and wrap each other up like we've been apart for years.

We take a highway bus through the steep, winding, bone-coloured Judean hills. It is warm; the sky blazes blue. No clouds. We pass several bone-coloured, flat-topped towns and the occasional date palm. Through a ravine and over a hill and here before us–

Yerushalayim. al-Quds. City of Gold. Jerusalem.

Naava is staying with relatives and I'm booked into a convent in the Muslim Quarter of the Old City. Jerusalem is divided in many ways and on many levels. One – denoting history – is the demarcation between modern East and West Jerusalem, and the Old City, which itself is divided into the same four quarters laid out by the Romans in 135 CE.

Along the stone paths of the Old City I walk with Chassidic men, IDF soldiers carrying Tavor assault rifles, Russian tourists, secular Israelis, men shrouded in white keffiyeh and women in hijab and long dresses. Here is a donkey and some boys on bicycles, here are women sitting cross-legged on the side of the road selling mint and parsley. Now the smell of Arabic coffee and cardamom and sweet nargilah tobacco.

I turn into the Via Dolorosa (Way of Sorrow) – the path Jesus took from Gethsemane to Golgotha. The front door of the convent is the tallest, broadest, strongest-looking dark wooden door I've ever seen, with a thick metal knocker. I knock.

Like many buildings in Israel, the flat convent roof is a place to gather for tea and conversation or for silent contemplation. I bring with me a copy of the Bible I found in my room. The roof overlooks the Temple Mount to the south, the Christian Quarter of the Old City to the west and rising up to the southeast is the Mount of Olives. Everywhere domes and minarets and church spires and stone crosses and aerials and antennae and electrical wires.

I read from the Psalms and watch the light fade. There's a slight breeze and the air smells of dust and cedar. A flock of grey and white doves weaves and rises and falls and rises above the roofs towards the sun and just as they reach its lower pole, they turn as if faced with God and burned, and dive as one back to earth.

‘How beautiful you are my darling! Oh, how beautiful! Your eyes are doves.' Song of Songs.

This city is more than history and architecture and culture and religion. It is intensity of feeling – it's on people's faces, it has moulded into their bodies and permeated the stone streets. It's everywhere, this thing I'm searching and searching for – meaning.

Dawn.

‘Allahu Akbar, Allahu Akbar,

Ashhad an la ilaha illa llah . . .'

A local Muezzin calls the Islamic faithful to prayer; his melismatic voice stretches out over the Old City. I get up from the narrow bed overhung with a crucifix and re-align the scratchy blankets and take the lithium and pericyazine and venlafaxine with water and walk down El Wad Road to the Jewish Quarter for an Israeli breakfast and sweet mint tea.

In the Christian Quarter further west is the Church of the Holy Sepulchre, visited by 16 centuries of Christian pilgrims. Inside, it's more a collection of chapels, dark and cool. Electric lanterns and candles provide light. The floor is mostly marble and the walls and stairs are limestone. The voices and feet of tourist groups echo up into the vaulted roof and fall down again like rain.

People are kneeling in prayer before the Twelfth Station of the Cross – the site of the crucifixion. Over the bare rock is a marble altar, and above that, a life-size statue of Jesus. Surrounding him are oil lamps and candles and a reflecting relief in silver and gold that makes my eyes water.

The peripheral chapels are still and sombre and grey-brown dark. I run my palms over lines of crosses etched into the walls – some date back to the time of the crusades. I close my eyes and breathe and my heart runs, blood runs and fills and deepens.

Later Naava and I explore Ir David – the archaeological site outside the walls of the Old City that is, says Yael our guide, the location of Biblical King David's Palace. Suddenly I'm standing on land that has had significance for people for over 3000 years, and whose ownership remains fraught. The continuing excavations are encroaching on the Palestinian town of Silwan.

We have dinner in the Muslim Quarter. Naava and I are the only women sitting on tiny chairs on the side of the street, drinking coffee, black and strong and flavoured with cardamom. We order a nargilah. The coals have been burning for hours so the smoke is at once thick and sweet and . . . the world is spinning.

We stretch out our legs under the table. The men stare for a while and then resume their conversations.

‘This is amazing,' I say.

‘It is,' says Naava. She looks like she's going to melt into the chair.

‘I mean this part of Jerusalem . . . being here . . . right at this spot right at this moment. Here with you. Amazing.'

The next day is Holocaust Remembrance Day. I walk up the narrow, winding road to the Mount of Olives. Its slopes have been used as a place of burial for millennia. It is here that the Messiah will first appear before passing through the Golden Gate to the Temple Mount. It is from here that Jesus ascended to Heaven. And here is the sunrise over the Old City, flushing the pale limestone tombs, blushing the city walls and polishing the Dome of The Rock from burnished to bright gold. Oh Yerushalayim, the light, the light.

The sirens start at 10 a.m. A steady wail, a cry of pain, higher in pitch than a lament. The cars and buses and trucks on Jaffa Road stop. People turn off their engines and get out and stand still and silent in the middle of the road and bow their heads. I stand and bow my head. The sirens keen for two minutes, after which, people continue quietly on their way.

This land is sacred to all three monotheistic religions and to Sufis, Druze, Baha'i and Bedouins. The land has been fought over by Egyptians, Greeks, Romans, Ottomans, Crusaders, Turks, Napoleon and the British. There are communities here from Ethiopia, North Africa, the Mediterranean, East and West Europe, Yemen, Iraq, North and South America. There are endless questions. There is absolute certainty and absolute unease. I'm expanded and gripped and flung apart and I feel again as I do observing the stars: infinitely small and finite.

‘Pray for the peace of Jerusalem: may those who love you be secure. May there be peace within your walls.' Psalm 122.

Where Jerusalem ends, the desert begins – the Judean desert to the east, the Negev to the south. I'll travel on my own for a week and then meet Naava in Eilat by the Red Sea.

Everyone drives fast in Israel. This is my first time driving on the right side of the road in a left-hand-drive car. It's crazy. Somehow I memorise enough of the map to allow me to concentrate on avoiding hitting anything till I reach the wide, straight Number 6 Highway.

There are Bedouin tents hunched into the hills, rusting cars and sheet metal, rubbish piles, donkeys and goats. Large towns become smaller towns, then a Kibbutz with date palm plantations and occasional bursts of wildflowers. Then desert – dusky rock dotted with army-green shrubs. The ‘lone and level sands' stretching far away.

Amid the occasional bank of army tanks and the desert and the deepening light. I find Mitzpeh Ramon: a town perched on the rim of the largest naturally formed crater in the world, and one of the best locations for desert hiking.

At sunrise I pack a good topographic map, compass, plenty of water, fruit and a hat. I'm wearing long loose pants and a long-sleeved shirt.

Walking along the wadi – the dry riverbed. No trees. No plant-life. No animals, no insects. Just the mustard and muddy-red sides of the ravine and the sandy ground under my feet.

No wind.

If I stop walking, absolute silence.

Then four jet fighter aircraft in formation. The lower thud of Apache helicopters.

Absolute silence.