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The world's longest suicide note: ONE MILLION words.

I write about life with bipolar disorder (a.k.a. manic depression).

All opinions are my own.

twitter.com/ManicGrant

nick@manicgrant.com

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The Journey

11 min read

This is a story about three years of my life...

Hotel room

I was living in an ultra-modern hotel in Canary Wharf and working for HSBC at their head office. I was a member of the team working on the bank's number one IT project. Shortly beforehand I had been living in a 14-bed hostel dorm and I'd narrowly escaped bankruptcy and destitution. I was working 12 hours a day, 6 or sometimes 7 days a week. I was exhausted and the tiredness, stress and unsettled life was driving me literally insane. I was suffering with delusions of grandeur, paranoia and my behaviour was erratic and unpredictable; I was extremely tense and irritable. I was on the brink of having a breakdown.

River panorama

I rented an apartment on the River Thames near the office. The rent was obscene - £500/week - but I was earning great money working for HSBC and I was working very hard, so it seemed affordable at the time; it seemed like a nice reward for all the hard work. It felt like justice that I'd been able to get myself off the streets and into such a lovely place to live; to have gone from homeless and sleeping rough in a park, to having a luxury Thameside apartment with panoramic views over London.

My glasses

I was dating a BBC journalist. I was rapidly gaining a Twitter following. I felt like everything was happening for a reason. I felt like it was my destiny to do something important. I was consumed with mania; I was obsessed with the idea of a grand gesture. I had been deeply affected by my homelessness and near-bankruptcy and destabilised by the exhaustion of sleeping rough and in hostel dorms. The IT project was very stressful and I was under a great deal of pressure from HSBC management. My mind was a mess. I was very severely mentally ill.

Psych ward terrace

I woke up one morning and I couldn't go on. I couldn't face the office. I wanted to kill myself. I went to my doctor who sent me to hospital. 13 hours later I was admitted to a secure psych ward. I explained that I was financially distressed and very stressed at work. The psychiatric team recommended I stay in hospital for at least 2 weeks, but I needed to be back in the office if I was going to keep my job, to be able to afford the rent.

Golden Gate Bridge

I discharged myself from hospital after a week and flew to San Francisco. I figured that if I was going to kill myself I might as well do it somewhere iconic. A friend picked me up from the airport and I borrowed a bike. I cycled straight to the Golden Gate Bridge. Seeing old friends, however, made me change my mind about committing suicide.

Sleep out

I lost my job with HSBC and I "slept rough" in the shadow of the head office skyscraper in Canary Wharf. I thought that this would be the pinnacle of my journey. I thought that having been used and abused by HSBC then unceremoniously dumped out onto the streets to suffer bankruptcy and homelessness - having managed to get myself a job at the bank while of no fixed abode and living in a hostel - would be deliciously poetic. It was, but my journey had barely begun.

Self harm

I quit drinking for 121 consecutive days. I starved myself. I thought that I would go on hunger strike. I thought that I would sleep rough on Christmas Day. I was really angry and upset with the world. Self harm and substance abuse dominated my life for several months. I got into heaps of debt just staying alive.

Cruise ship

I survived the winter. I got another job. My life was OK except for persistent suicidal thoughts. I hated the project I was working on but I persevered because I was in a lot of debt. I loved where I was living - every day in my apartment was like Christmas Day because the view was so awesome. Living by the river was an incredible privilege. I took a holiday and went kitesurfing. My quality of life was improving slowly.

Cooking with bath salts

I met somebody very special and fell totally in love. She accepted me for who I was, including the all the bad bits, such as my prior issues with substance abuse. She was the first person I'd been in a relationship with who'd been able to read everything about me on my blog and to understand my flaws. We had a good relationship. The project I had been working on came to an end and I was jobless again. I wrote and published my first novel - she proofread it and helped me with the ending and other ideas. She was very supportive and I was confident I'd find work again easily.

New Year's Eve

New Year's Eve watching the fireworks over London, sipping champagne on my balcony with the woman I loved - it seemed like the New Year was full of promise, but I was worried about getting another job and I was still in a lot of debt. There was a lot of pressure.

DVT

Disaster struck. I got deep vein thrombosis (DVT) in my left leg, which swelled up to twice the size of my right leg. My kidneys failed and I ended up in hospital on a high dependency ward having many hours of dialysis every day. The potassium in my blood spiked to a life-threatening level and I was constantly at risk of cardiac arrest. I was very sick.

Drug shrine

My stay in hospital caused me to lose my job. Losing my job caused me to collapse psychologically and become very depressed and despondent. The DVT had caused terrible nerve damage and I had a lot of neuropathic pain, as well as a numb left foot. I started to become dependent on painkillers. I sought powerful antidepressants for my low mood. Pictured on the table are: codeine, dihydrocodeine, tramadol, diazepam, alprazolam, mirtazapine, venlafaxine, dextroamphetamine, zolpidem, zopiclone and pregabalin, which are all highly addictive. Because of this cocktail of prescription drugs I suffered an episode of medication-induced mania - temporary insanity - and broke up with the love of my life.

Manchester flats

I ran out of money. I had to pay a huge tax bill and I had to go even deeper into debt. I was virtually bankrupt. Out of desperation I was forced to put all my worldly possessions into storage and leave London to take a job in Manchester. The job in Manchester included an apartment as part of the package, which was lucky because I didn't have enough money to pay rent or a deposit - I was totally broke. Moving house and leaving London was incredibly upsetting and traumatic. The new job was extremely demanding and exhausting. I was very lonely and isolated in an unfamiliar city with no friends or family; no local connections.

Psych ward fence

I tried to commit suicide. I took a massive overdose: I'd been stockpiling my prescription painkillers and I knew that 8+ grams of tramadol was likely to be fatal. I sent a tweet when I believed I was beyond the point of no return. I thought nobody knew where I lived. I thought there was no chance anybody would get to me in time. I was wrong. I regained consciousness a few days later in a hospital's critical care ward on life support. I was later sectioned for 28 days and admitted to a Psychiatric Intensive Care Unit (PICU).

Hay bales

A doctor from Wales discovered my blog and invited me to live on their farm in a converted garage. I had no money, no car, no job. I had nothing.

Rat race

I almost went bankrupt but a friend got me some work in Warsaw and in London. I was living in AirBnBs and working in the Square Mile from Monday to Friday and living in Wales at the weekends.

Keys

I bought a car, I got a local job, a local girlfriend and I rented an apartment. Briefly, I had everything I wanted and needed, although I went even deeper into debt. The pressure, stress and turmoil which I'd endured to get to this point was unimaginable; just to get to a position which most people would take for granted as the minimum acceptable things for a normal ordinary liveable life.

Papered windows

The local project ended and I was jobless again. The relationship ended. I papered over my bedroom windows and withdrew from the world. The journey had destroyed me. I was spent.

Cashflow

An obscene amount of money flows through my hands, but it all ends up in the pockets of those who I owe money to. I'm desperately trying to keep my head above water. The financial pressure is immense; unbearable. The journey has been incredibly long and arduous. There's still a very long way to go before I reach security and stability; before I'm comfortable, happy and content.

Empty wine bottles

In the last year alone, I've managed to move house 3 times, work 4 different jobs, travel to 4 different countries, date 2 girls, survive a suicide attempt, be admitted to 3 different hospitals, quit addictive painkillers, sedatives, tranquillisers and sleeping pills, be arrested and locked in a cell, buy a car, rent a place to live, stay in 17 different hotels and AirBnBs, and somehow stay on top of my mountainous debts, not go bankrupt and even pay some of that crippling amount of money back. My only remaining vice is wine. I'm completely unmedicated and I don't abuse any substance other than alcohol. It's a remarkable journey for just 12 months, but the journey has been much, much longer than that.

In the last three years, I've written and published a million words and connected with thousands of people all over the globe.

To be precise, to date I've written exactly 1,001,020 words and counting, on this blog.

It's the world's longest suicide note.

If you want to understand why I'm suicidal you just have to read it all - it's all written down in exquisite detail. To save you the trouble of reading all 1 million words I've summarised the last 3 years for you right here.

The pressure; the stress; the exhaustion. Where is my reward?

I've travelled so far and I've achieved so much but yet I feel like it's gotten me nowhere. I should be rich but in fact I'm up to my eyeballs in debt. If you want to know where that debt came from, I just explained it to you. I didn't get into debt buying frivolous things and being profligate. I didn't make particularly bad choices. I'm not stupid. Where's the payoff for working so hard? Why did I bother?

My name's Nick Grant and I drink too much but otherwise I'm an ordinary regular guy. I do my job to a high standard and I'm liked and respected by my colleagues. I pay my taxes. I pay my rent and bills. I contribute to society as a productive member. I do ordinary stuff and have ordinary needs.

I'm 39 years old and I have nothing but debt. I have nothing much to show for my 39 years on the planet.

I'm lonely. I live a double life. The person I am in the office is different from the person I am in the comfort of my own home. Nobody at work would ever suspect that I've slept rough, been in trouble with the police, been hospitalised many times, been sectioned and had horrific problems with addiction. Nobody would suspect that my mental health has caused me horrendous difficulties when exacerbated by stressful life events, like divorce, moving house, losing jobs and everything else that's happened to me in the past 5 or so years.

My solution to the instability in my life was to create a backbone that has run consistently through my ups and downs: my daily writing. To have been able to write a million words has been immensely stabilising and has brought me into contact with so many wonderful kind and caring people. I quite literally owe my life to those who've followed me and my blog, especially via Twitter. Without this connection to the world I would be dead.

Today, I've crossed a seemingly arbitrary imaginary finishing line, in having written and published a million words in less than 3 years. It might seem ludicrous and pointless, but if you consider it in the context of the journey I've been on, you can see why I've wanted to document it.

If you've followed me on some part of this journey, I'm really grateful to have had your support. Thank you.

 

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First, Do No Harm

6 min read

This is a story about primary care...

Your GP Cares

Primum non nocere is in and of itself a non sequitur because the use of Latin and other languages of classical antiquity is primarily intended to deter the hoi polloi from becoming educated. The number of doctors who are able to train, qualify and practice, is something that is tightly controlled in order to maintain high salaries - artificial scarcity - as opposed to allowing the unrestricted proliferation of medical knowledge which might improve the health of the nation.

Those who profess the Hippocratic Oath might be able to stay true to the vow they have sworn if they practice the treatment of acute illness in a hospital - dealing with curable disease and injury - but in the treatment of chronic illness in the community, as General Practitioners (GPs), can we say the same?

If we look at a few obvious statistics, we can see that medicine is failing. Average life expectancies have started to fall and chronic illness has seen a dramatic rise. There is an epidemic of mental health problems, and suicide is the biggest killer of men under the age of 45.

Of course, one might say that the root causes of these conditions are non-medical.

It occurred to me that a significant piece of the NHS has already been privatised, in that many general practice surgeries are owned and operated as private profit-making enterprises. This seemed to present a significant conflict of interest, so I decided to conduct an experiment.

I asked a GP a simple question: when you're treating a patient, do you think about their healthcare needs, or do you think about other things? The reply was shocking.

"It's not about [the patient] it's about everybody else"

I'd had my suspicions for a while - gathering plenty of evidence - that those who profess to do no harm might actually have been corrupted into serving other purposes; into betraying their profession and failing in their duty of care. This was the final confirmation that my worst fears were realised, and there are powerful actors within the healthcare system who place other things above the health of their patients.

By co-opting doctors into the capitalist profit-driven sector of the economy, and by co-opting them into the welfare system, we are asking doctors to choose between their luxury cars, the private school fees for their children, and other trimmings associated with their high social status, versus increased taxes to pay for the welfare state. By placing the most vulnerable people in society in front of the doctors, when seeking incapacity benefit, the government is pitting one group against another.

If the study of economics has taught us anything, it's that people respond to financial incentives. While a GP might argue that they're saving valuable taxpayer money, which might be spent on the NHS, by denying incapacity benefit to a vulnerable member of society, one must also admit that the GP acts in rational self-interest. Less money spent supporting society's most vulnerable means a lower tax burden and more money in the pockets of the profiteers, which include GPs who are partners in their practice.

The first principle of do no harm forbids a doctor from weeding out malingerers based on their best guess. To cut off somebody's incapacity benefit is definitely harmful, and there is no diagnostic test which could decide with a high degree of accuracy who is the malingerer and who is genuinely unable to work. If the doctor in question truly cares about their patients, they would have no option but to choose the option which gives most benefit and inflicts least harm.

We see so many suicides because patients are fobbed off with inferior treatment options, because it's a cheaper alternative to give somebody pills than to give them psychological therapy. While I understand that being cost-conscious might be seen as being pragmatic, it again violates the principle of do no harm. To fob a desperate and vulnerable person off with ineffective medication, when better treatment options are available, is tantamount to negligence. If a doctor has a consultation with a man under the age of 45, they must surely be well aware that suicide is the thing that is most likely to cause their death, and they should therefore treat it as a serious threat to their life. To call people's bluff and knowingly prescribe ineffective treatment is obviously the reason why suicide rates are so scandalously high.

I imagine that some doctors - although egotistical and in love with themselves - have a tiny piece of them that wants to make a difference and save lives. I think that exhaustion and the pressures that are felt by ordinary people are imposing themselves on doctors now, who are struggling to send their children to the best private schools (boo hoo) and are feeling compassion fatigued because of burnout. If we can relieve the pressure on GPs, they may become more willing and able to work in support of their patients' needs, as opposed to "everybody else" (read: being the government's job police).

I strongly believe that we have an urgent need to change primary care, so that it becomes not-for-profit, and patient healthcare can become the primary objective. Perhaps profits are not the primary motivator, but money has a corrupting influence which can be clearly seen when you speak to a GP who is/was a partner of a practice. Co-opting healthcare professionals into the job of coercing vulnerable people into bullshit McJobs, where they are exploited by the capitalists, has absolutely nothing to do with healthcare and is most certainly harmful.

I've witnessed first-hand how this care for "everybody else" - instead of patients - has become shorthand for the compassionless, sympathy-lacking, bullying, hectoring and suicide-inducing grotesquely twisted vision of so-called medicine, inflicted on society's most vulnerable people.

If you want to be the job police, and you think that suicides are an acceptable price to pay, so you can feel superior and send your kids to private school, perhaps medicine is not for you.

 

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Notes on a Suicide - #WorldMentalHealthDay #WorldSuicidePreventionDay

8 min read

This is a story about slipping through the safety net...

Discharge summary

Exactly one month ago was World Suicide Prevention Day and exactly one month ago I was in a critical condition, on life support in intensive care. I was given a 50/50 chance of living or dying, following an overdose the night before. It seems sickeningly ironic that if the emergency services had reached me just a little bit later, I wouldn't be writing this. If I didn't live in the United Kingdom, where we have the best healthcare system in the world, I would probably not be writing this.

It was 9 years ago that I first sought help for my mental health. "Have you heard of fluoxetine?" asked my doctor, within 30 seconds of me explaining my symptoms: suicidal thoughts, low mood, low energy and an inability to get out of bed and go to work like normal. I was disappointed to be offered patent-expired generic medication, without a moment's hesitation. I walked away empty handed.

Clinical depression was where I started my mental health journey. Having the label "clinical" made a huge difference. To add that word - clinical - onto how I was feeling, was necessary to defend myself from anybody who might say "just snap out of it" or "pull yourself together". In my case, having a label was desirable - it wasn't an excuse; it was a diagnosis.

Every time I've gone to my doctor, I've been hoping to receive some counselling, but instead I got referred into psychiatric services as an outpatient in 2010. I was referred for Cognitive-Behavioural Therapy (CBT) treatment, but by the time I was assessed, my mood disorder had been diagnosed as type II bipolar disorder. The assessment concluded that my mood disorder was too severe to be treated with CBT. I was left with no psychological treatment. "What am I supposed to do?" I asked. "Go back to your doctor" came the reply. It was a devastating disappointment.

By 2011 I was so unwell that I was assessed under the Mental Health Act, to see if I needed to be detained in hospital - what is colloquially referred to as a "section". I begged to be hospitalised as I was suicidal. I repeatedly said the classic cliché that so many people will say when they are desperate for help: "I'm going to kill myself". Community Mental Health Teams (CMHTs), crisis teams and home treatment teams must hear those words so often.

With a shortage of psychiatric beds, there's a huge reluctance to "section" anybody. At the time of my first section assessment, my girlfriend and my dad were present, so the assessment concluded that I could be kept safe at home. In fact, I sawed a hole in the back of my shed, climbed over a neighbour's fence and ran away. The police were called to look for me because I was a danger to myself.

Soon after that, I was seen by a private psychiatrist, referred and admitted for 4 weeks of inpatient treatment at a private hospital. The cost was over £12,000.

There was some debate with my medical insurance company as to whether my bipolar disorder was acute or chronic. The insurance company said it was a chronic condition, and therefore not covered by the policy. The consultant whose care I was under, managed to argue - over the course of a couple of nail-biting weeks - that my presentation was acute.

Having to resort to the private sector; having disputes with an insurance company - none of this was conducive to getting better. In fact, having to find my own psychiatrist, get approval from the insurance company to even speak to the doctor and then having the stress of thinking that I might need to spend £12,000 of my dwindling savings, was an awful ordeal when I was clearly very unwell.

At the end of 2012 I got married and 8 months later I separated from my wife. She didn't care about the incredible stress that divorce and selling our house would put me under. I moved to London to live with supportive friends while my life was ripped to pieces. I lost my job.

By 2014, I completely slipped through the safety net. I took an overdose and lay dying of multiple organ failure on the floor. I managed to phone a friend who got me to hospital. After a week, the hospital discharged me to a hotel. I had two weeks to organise my own accommodation because no bed on a psychiatric ward could be found for me. My muscles were horribly damaged by the overdose and I was in agony. With a bundle of documents to prove that I was a priority case for emergency housing, I visited the local council housing department. The officer I saw promptly disappeared on holiday, abandoning my case. I became homeless.

After living in cheap backpackers' hostel, I reached my two week limit, which is a rule that most hostels have. I then started living in a bush in Kensington Palace Gardens. When it became apparent that living in a bush was not a long-term solution, I stumbled into nearby Paddington - St Mary's Hospital - and presented myself at Accident & Emergency. 12 hours later, I was given two weeks respite in a "crisis house". I tracked down the housing officer who I'd spoken to before. At the end of two weeks, I received a one-line email: I wasn't eligible for any help from the local council. Why? What now?

I was homeless on Hampstead Heath. It was very beautiful, but it was still summer. What was I supposed to do when the weather turned bad?

How had this situation come to be? I'd been a highly functional, productive and fine upstanding member of society: I'd had a successful career, paid taxes all my working life, bought a house, gotten married and done all the things we're supposed to do. What the heck was I doing homeless and abandoned by the state when I was obviously a vulnerable adult? My doctor had written a letter saying I was a vulnerable adult, and my psychiatrist had done the same. These letters had been presented to the local council housing officer, but yet it had made no difference. What have you got to do to get help in this country?

Eventually, I came to be living in the North of England, in an apartment which was a perk of a job I'd taken out of desperation. The apartment was miserable, dark and dingy, and I was terribly lonely. On the 9th of September 2017, I took a massive overdose, which I had researched on the internet to make sure it was likely to be fatal. I regained consciousness after having been in a coma, in hospital, on the 11th of September 2017 - I had completely missed World Suicide Prevention Day. A machine was breathing for me and I was put back to sleep. I didn't leave the intensive care and high dependency wards until the 12th of September 2017.

On the 13th of September 2017, I found myself discharged from hospital and left to flounder all on my own. I didn't want to go back to the apartment where I'd tried to kill myself. I've not been back there. I'll never go back there.

I was sectioned - a section 136 - after being taken to hospital by police. I had to make a massive public nuisance of myself in order to get help. The hospital upgraded me to a section 2, which meant I was going to be kept on a psychiatric ward for up to 28 days. Why now? I'd had two near-fatal overdoses, which had hospitalised me in a critically ill condition, but yet I hadn't been considered enough of a risk to myself to receive inpatient psychiatric treatment. Why did it take so long to finally get the treatment I'd been begging to get for 6 years?

The psychiatric ward discharged me from my section after 12 days, and another week later I was discharged from hospital - a good samaritan has taken me into their home. Again I wonder why no temporary housing was forthcoming, given the fact I am so vulnerable - I lost my job and my apartment due to mental health discrimination. I'm being victimised again & again.

I'm in a safe place now, but my food & accommodation comes from a charitable family who have taken pity on me, after reading my story on my blog - we clearly don't have a system that works for the whole of society. We can't all turn to Twitter every time we're having a mental health crisis.

My Twitter followers brought the emergency services to my door, saving my life. Through my blogging and social media presence, a stranger read about my desperate plight, and kindly offered to take me into the family home.

Today, I feel OK, but why have I been subjected to such a horrific ordeal? I very nearly succeeded in ending my own life, because no help was forthcoming when I really needed it - we're locking the stable door after the horse has bolted.

Using myself as a case study, the safeguards we have in place to prevent suicides are woefully inadequate. My first-hand experience of NHS mental health services, is that they're desperately underfunded and overstretched.

There will be so many tragic preventable deaths if we allow the current situation to persist.

 

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Hospital Curtains

6 min read

This is a story about modesty...

Psych ward male dorm

It took 12 days to be "discharged" from my section - that is to say, to be allowed to leave the secure psychiatric ward whenever I wanted. However, it took 21 days before I was actually discharged from hospital: no vulnerable adult can leave hospital without a discharge plan, although I could have discharged myself against the advice of the healthcare professionals who were taking care of me, because I was a free man.

I'd been assessed to see whether I needed to be detained under the Mental Health Act at least 5 times. 6th time lucky.

When you find out for the first time in your adult life, that you're about to be detained against your will, I would've thought that everybody would have a similar reaction: "oh my god, I'm now trapped somewhere I might not want to be, and I don't have any say in the matter" which is distressing.

It's not so much that I didn't want to be in hospital; it's that I couldn't leave even if I wanted to. Although I wanted to be in hospital - because I knew I was very sick and in a dreadful situation - there was still a moment where I thought "oh shit what have I done?".

To calmly accept your plight is not something that would be anybody's natural reaction. Under such stress and shock, it's hard to recognise immediately that any attempt to fight against the system will lead to further difficulties. I was least surprised out of anybody that I got sectioned, having been the one who actually phoned the police to come and get me. Of course, escape is not hard if you're determined enough. I was conflicted - I was safe, but the price I paid was my detention: I lost my liberty.

Running away from a psych ward will result in the police being called to look for you. Britain's most dangerous psychiatric patients are kept in facilities which are far more secure than anything I experienced. I could have escaped easily and the police wouldn't have tried very hard to find me - I was a danger to myself but not others.

Our natural reaction to detention is to panic and start yelling for anyone who can possibly get you out - a solicitor, a social worker, a family member - and to start demanding your rights. There's a process that's got to chew you up before it can spit you out, and once you've just started the rollercoaster ride there's no getting off until the end - scream if you want to go faster.

Despite my messed up state, I knew that I had the right to appeal my 'section' with a tribunal supposed to happen within 7 days. I knew that my dad had the right to request my release, with a decision having to be made within 72 hours. I didn't have much hope that my dad would be helpful, so I requested an appeal.

It's so damn hard to get any treatment for mental health problems, beyond some cheap patent-expired generic medications or a computer-based Cognitive-Behavioural Therapy (CBT) thing. Inpatient hospital treatment, paid for by the NHS, is only given to very unwell people or exceptionally stubborn & determined people. However, when you have been admitted to hospital once as an inpatient under a section, you might struggle to ever escape the revolving doors.

Many of my fellow patients had the same story - they were released from hospital, stopped taking their medication, went mad and were brought back into hospital, where they were forced to start taking medication again... eventually being released and starting the whole process again.

Note, when I say "forced to start taking medication" I literally mean that they were held down by a whole gang of hospital staff members and forcibly injected against their will.

It would be stupid to argue that psychiatric medication is entirely unhelpful. However, one should be mindful that a perfectly sane person who had been taking powerful antipsychotic medication, would experience extremely powerful withdrawal symptoms if they stopped. Antipsychotic withdrawal symptoms are indistinguishable from the spontaneous psychosis that occurs in a person with a mental illness - how can one distinguish between a madman and somebody who's experiencing the perturbations of a brain that's readjusting to medication-free homeostasis?

As we move towards a world where the majority of us suffer near-debilitating levels of anxiety and depression, and psychiatric medications are dished out like candy from general doctors who have no specialist training in the treatment of mental health problems, are we diagnosing disease when we should be looking at what a person's life circumstances are like?

Ironically, I was diagnosed with adjustment disorder, which is to say that I simply couldn't cope with stressful life events - a clinical label for an intolerable clusterfuck of dreadful stuff which could happen to anybody. There isn't a pill for adjustment disorder, yet, although a bottle or two of wine each night is often chosen as self-medication.

The stress of living with 20+ mentally ill men in a locked psych ward is something that most people would not adjust to particularly easily. The 4 walls of my home were replaced with a curtain, which was opened every 15 minutes by a nurse or a support worker to observe what I was doing.

I think psych wards are necessary and I'd rather have the apparatus that treats mental health problems, than not have it at all. This is not an essay that criticises mental health treatment or the hardworking professionals who care for people with mental health problems. I write merely to reflect on my journey through the mental health system, which finally ejected me yesterday. I'm coming to terms with the fact that I was discharged from hospital, and today is the first time in weeks where I have woken up somewhere I can leave without having to ask permission.

Yes, I think that sums up yet another Earth-shattering overnight change to my life: I've gone from a flimsy curtain and a locked door, to 4 solid walls and I'm free.

 

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A Tale of Ten Beds

7 min read

This is a story about how nothing really mattress...

Double bed

This is the last double bed I slept in, 27 days ago. That's my brand new bedding with brand new pillows and a brand new duvet. I moved to Manchester with nothing more than my laptop and a bag of clothes. New life - clean slate. This is the apartment where I tried to kill myself. It was a miserable place and I'm glad I never slept there again.

I woke up on Saturday 9th September, and I was miserable. I wrote a blog post in this bed, about how miserable I was and how close I was to committing suicide. It was prescient.

The next bed I lay upon was owned by a guy who I had become friends with through my girlfriend. My girlfriend at the time was of no fixed abode - sofa surfing with a guy who she met on a dating website. I'd travelled to this friend's apartment to see my girlfriend. We lay kissing and cuddling on our friend's bed. Then, we broke up.

Coming home to my miserable apartment, I didn't get into bed - I took a massive overdose and lay on the bathroom floor in the dark, waiting to die. The next bed I laid upon was in the Accident & Emergency department of the nearest hospital.

I'm presuming - because I was unconscious - that I stayed on the same hospital bed, as I was transferred from A&E resus to the Intensive Treatment Unit (ITU) and then to a High Dependency ward. I was on life support. I was having seizures. I don't remember any of this.

I vaguely remember having to scramble across onto a different bed, to move me out of the High Dependency ward and onto a general ward. I remember this because there was a bag of my piss sloshing around that had to be moved too, and there was a tube coming out of my penis, which I had to be careful not to entangle with anything. The tube that was going up my dick yanked my male member around - it wasn't a comfortable experience.

From hospital I was thrown in a police cell. There was a 'bed' made of concrete painted with light blue paint - the same glossy paint that adorned the floor and walls of the cell. To slightly soften the hard concrete, there was a thin blue foam mat, which was wipe-clean. I did not sleep.

Driven home by the two police who had interviewed me - at 2am in the morning - I finally got back home at 3:30am. My sleep medication was nowhere to be found and I'd had a traumatic day - sleep was impossible. I lay awake on my bed, waiting until the earliest possible moment I could go to the office and try to find a work colleague - I was in a desperate situation and I needed help from somebody friendly and sympathetic to my plight: alone in a strange city with no friends or family; no smartphone, laptop, debit card, credit cards, cash or driving license.

After a second dreadful day I was pretty fucked up, as one might expect of somebody abandoned in such shitty circumstances. As sleep deprivation reached the 40+ hour mark, I ended up back at the same hospital's Accident & Emergency department that I had been in 5 days earlier.

Another day, another hospital bed. This one I came round face down on, with my wrists handcuffed behind my back, after having received an intramuscular injection of 4mg of lorazepam. It was approximately 3am in the morning - now 6 days after my original hospital admission.

Sectioned first under a 136 (up to 72 hours) and then upgraded to a section 2 (up to 28 days) I was then taken to a secure psychiatric facility with airlock-type doors, to stop anybody escaping. I was given a private room that was quite nicely appointed, with a writing desk and an ensuite wet-room.

Psychiatric intensive care

Having blearily come round in the early hours of the Tuesday morning, it was now Thursday night. I finally had a single bed in a comparatively peaceful environment in which to collapse and sleep, mercifully with the assistance of some zopiclone to calm my jangled nerves and soothe me into my slumbers.

Gone were the bleeps and hisses of the machines that were keeping people alive, on the Psychiatric Intensive Care Unit (PICU), replaced with the sound of alarms, slamming doors, shouting and running in corridors, as my fellow patients were restrained by staff. I found it somewhat comforting, to know that my crisis was no longer at its peak.

After 8 days on the PICU, I was transferred to an acute psych ward. It was terrifying.

With me in hospital I had two Apple iPhones, two Apple Macbooks, a Nintendo Switch and £1,150 in £50 notes. It's not really recommended to have that amount of valuables on your person, in amongst some very poor and deprived people. The wealth disparity was vulgar.

My guardian angel facilitated the return of my surplus iPhone and Macbook - Apple were excellent and refunded me with no quibbles.

I begun life on the new ward in a private bedroom, but I didn't have an ensuite shower and the TV blasted right next door for 19 hours a day, at full volume. At first, I was too tired to care and I could sleep through the dawn chorus of utter bullshit television a million decibels, but then it started to keep me awake, leaving me less than 5 hours of shut-eye per night.

Psych ward TV torture chamber

Then, the dreaded dormitory. Dorms are a mixed bag - very dependent on the luck of the draw, in terms of your fellow occupants. Security is a massive concern, as nothing more than a privacy curtain separated my personal possessions from anybody who'd care to have a look through my bags. Snoring can be a pain in the arse, with one person able to keep everybody else awake listening to their noisy slumbers. Thankfully, my dorm buddies weren't too bad.

This morning I woke up to "second; minute; hour; power; shower" repeated over and over, as a poetic dorm buddy wrote a new rap. That was 5:15am. It was still dark. He was pretty loud. He's sleeping now - snoring.

Today, I'm bustin' out of the psych ward. Watch out, general public of the United Kingdom - I'm going to be moving among you again as a free man.

Psych ward dorm

This is my current bed. I'm lying on it as I type this. I don't know what the bed or the room I'm sleeping in tonight looks like - I've never set foot in the house I'm going to travel to this afternoon. It's a leap in the dark, as is my wont.

Some of my few remaining worldly possessions are here with me in Manchester and some are in London. I'm surprised that I haven't lost more of my valuables. I can't quite bring myself to do the maths, to figure how much money I've lost on this crazy jaunt to the North of England. What does it matter? I'm alive and about to be accepted into the fold of a kind family who are taking me in - the IT consultant who lost his mind in a city where he didn't have any friends or family. It's unlikely that I'd have ended up homeless, but I wasn't relishing the prospect of being chucked off the psych ward and into a dreadful bed & breakfast, in some shitty suburb.

The very definition of "my" home and "my" bed has been smashed to smithereens. Tonight will be the tenth bed I've lain upon in less than 28 days, including several hospital beds and the concrete slab that passes for a bed in a police cell.

Distress flares were fired off and a good samaritan is coming to rescue me from a fairly dire situation.

Tonight, I sleep in a normal house for the first time in what feels like a very long time.

 

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Care Quality

8 min read

This is a story about being inspected...

A tivities

Today the psych ward is being inspected by the Care Quality Commission (CQC) and the staff are so nervous that some of them feel physically sick. I try to reassure one nurse that they're doing their best, despite staff shortages and rampant drug use - the synthetic cannabinoid called Spice is ubiquitous throughout prisons and psych wards.

There's always somebody peering over your shoulder, sneeringly judging you. Is it any wonder that paranoia takes hold in a mind, destroying it? The United Kingdom has an exceptional ability to track the movement of its citizens, using simple conventional CCTV - no spy satellites even needed.

In the free West, we deride the Stasi and the KGB. We talk about China's vast number of people employed to snoop on their own citizens, but we don't acknowledge the work of GCHQ and the NSA. Have we forgotten Edward Snowden's revelations so quickly? The Government read your fucking emails and the police - the regular ordinary police - have a backdoor into Facebook to read all your private messages.

Nothing to hide, nothing to fear. If you believe that, why do you feel stressed if a police car is following you when you're driving, and a sense of relief when the police overtake you and disappear over the horizon? You have insurance; you've had your car's roadworthiness tested; you've paid your road tax... nothing to worry about, right?

It was only a short time ago that I was deeply indoctrinated by my schooling, that had shaped me into a meek conformist - I was fearful of defying any of society's rules and regulations. A family friend wanted to go fishing with me, and I said we needed to obtain a permit. "Our prisons are full of people who got caught fishing without a license" this friend laughed. "What are you in here for? Murder. What are you in here for? Fishing without a license" he continued jovially.

The city centre is crammed with 50,000 protestors preparing to march. I walk past a police cordon and I can hear a police officer yelling at me that I can't go the way I'm going, but I know that he'll be busy dealing with my obedient friend who will have stopped per the instructions. I keep walking, pretending to be unable to hear the entreaties to return. The policeman lets my friend go and we walk to the head of the march.

Police car

I'm sure that anarchy would be a disaster for sick and vulnerable people. I have no desire to see civilised society crumble. We can't all do whatever the fuck we want, whenever the fuck we want. Perhaps if everybody acted like I did, it would be the end of the world as we know it.

"Don't walk" says the sign in the United States. I jaywalk with gay abandon. Even in Manchester people look at me like I'm mad and suicidal, for the way I cross the road. However, it's done with such confident aplomb that nobody challenges me. I notice that people who are surrounded by plenty of steel and glass and plastic, such that they would suffer no injury at all if they killed me to death with their motor vehicle, do not give a single fuck about whether I live or die. In London, a motorist will slow down or even brake, to avoid killing a pedestrian, but these provincial plebs treat human lives with no such sanctity.

To live in a crowded city is to be humbled by humanity. To be detained against your will on an underfunded psych ward is to humbled, also. In the city, you are forced to confront your pathetic meaningless existence, as an ant crawling in its nest would be, if it had the faculties to perceive itself and its surroundings. But an ant's nest is akin to a row of gleaming skyscrapers, insofar as being a testament to what can be achieved by a society working together. On the psych ward, you are forced to confront your powerlessness over forces greater than yourself - society will exclude its troublemakers.

Perhaps you think I would endorse heroin being sold in supermarkets and that babies' pacifiers should be replaced with crack pipes?

As six police officers pinned me to the ground and my bum was injected with lorazepam, in the Accident & Emergency department of a hospital, I noticed a cleaner and a security guard nearby - some of the lowest paid people in society are often completely unacknowledged for the role they play in maintaining the division between the peasants and the aristocracy. My face was inches from the floor, but the policeman's trousered knee on my head was clean and so was the linoleum. Circles of red and green blinked at me - the police bodycams, videotaping the whole gruesome specatcle. I'd fallen from grace, but I hadn't slipped anywhere near the bottom - it's a long way down.

A friend whose judgement I trust and respect, tells me that I should drop the bad boy image of "the guy who got fucked up in Manchester". She knows that people are watching and I'm misrepresenting myself. She knows that people are lazy and won't look any deeper than the superficial image that I present.

Is my life - and the way I document it - by accident or by design? Do you imagine that when I'm writing, I don't think at all about how things are going to be perceived? The joke's on you if you don't read what I write with the prerequisite pinch of salt.

If you just dip in at random - like a care quality inspector - then you will get a random impression. On a good day you'll get a good impression. On a bad day you'll get a bad impression.

Violent restraints

Do you think the graph above shows that things are improving? No. No it does not. Things are getting worse. Much, much worse. The data above shows conclusively that during the period under examination, there was a fourfold increase in the very metric that was supposed to be cut by 80%.

Do you remember blue tablet man? Well, anyway, he assaulted a nurse for giving him a yellow tablet (5mg of diazepam) instead of a blue tablet (10mg of diazepam).

A drugs dog sweeps the ward. The patients believe the dog can sniff out cigarette lighters. I ask the handler if the dog can sniff Spice and he confirms that it can. There's Spice everywhere on the ward, despite its deleterious effect on the mental health of susceptible individuals - prodromal schizophrenia can turn into fully-blown psychosis under the influence of the powerful synthetic cannabis, making it all the more concerning that it's so widespread on an acute psychiatric ward.

The patients here are the lucky ones and they know it. Everybody agrees it's better to be here with a warm dry bed and three hot meals a day. Everybody agrees it's better to be here, where the chances of being beaten up and/or robbed are minimal. With winter on its way, months of unimaginable suffering lie ahead of Manchester's homeless population, which has increased 1,100% in just 7 years - and a huge number of them smoke Spice.

Abandon hope all ye who entered the world from the mid-1990s onwards. What are the prospects for the youth of today, and the glut of graduates who were promised that indebting themselves and spending three or four years at university would be a good move?

Does it not seem like an obvious reaction to a decline in living standards, to retreat into drugged-up oblivion?

We're sifted and sorted and dissected by tests. We're examined, inspected and measured in every conceivable way. We never have any respite from the world's desire to label us, grade us and monitor us. The pressure to meet the expectations placed upon us is relentless. Some of us will crumble and have nervous breakdowns or be paralysed by anxiety disorders. Some of us will rebel and kick back at the suffocating environment that's desperate to eject and marginalise anybody who doesn't neatly fit in a box. Lots of subcultures have sprung into existence, with members exchanging knowing looks - these people are so much happier now that they have rejected the stereotype they were supposed to embody.

It saddens me that the hard-working staff on the ward are anxious and on best behaviour, when the other 364 days a year I know that they try their very hardest. This is just one of many psych wards, where the macro problems are greater than anything that can be influenced in the microcosms.

If you're going to randomly dip in, be careful to not make a lazy judgement based on a small sample size.

 

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Promoting Health

8 min read

This is a story about being counter-productive...

Fire alarm

95% of my fellow patients smoke cigarettes. There's nothing to do on the psych ward, so I can see why they would. Cigarettes are a way to pass the time; to deal with boredom; to relieve some of the stress of being locked up with a load of mentally ill people; to self-medicate for all manner of problems.

Nicotine is fiendishly addictive and a psych ward is not the right environment to kick the habit. As a non-smoker I'm well aware that I'm not involved in the activity that dominates the lives of my fellow patients - obtaining tobacco, rolling cigarettes and harassing the staff to be let outside to smoke.

There is a small outdoor area which can be accessed via some steps, enclosed in a cage so that nobody can jump and injure themselves, or attempt to escape. Every hour, the door to the steps is opened for 15 minutes, and the smokers all cluster around the top of the steps, getting their nicotine fix. Nobody goes down the steps into the outdoor area - they remain in the cage.

I challenge the staff - why don't they leave the door open the whole time? Nobody could escape from the outdoor area, because it's surrounded by high fences. The outdoor area is well covered by CCTV, and it's no harder to keep an eye on people than any other part of the ward.

The standard response from the staff is that it's "promoting health" to deny nicotine addicts access to the only place they're allowed to smoke. I call bullshit on this, because there's no data to support the hypothesis. "Look around - everybody smokes... nobody is smoking less because of this rule" I say. The staff argue that the NHS can't be seen to be "promoting" smoking. This is a completely ridiculous idea. The nurses and support workers hand out the cigarettes and cigarette lighters - the NHS is intimately involved in the whole process of smoking, far more than if the patients were given the choice as to how they dealt with their addiction.

Steps down

I'm in a dorm with 3 other men. It's a lot quieter than the single room right next to the TV - the TV blasted out for 19 hours in every 24 at full volume. The noise was unbearable. My fellow patients in my dorm report that they're lulled off to sleep by the rhythmic tapping of my keyboard, as I pound out these words. I was concerned that I was being a noisy nuisance, but they reassure me that it's quite the opposite - it's a kind of white noise that's relaxing, like hearing raindrops falling on the roof or hitting the windows, driven by the wind.

A guy is coming out of my dorm, but he doesn't sleep in my dorm - he has his own room. What's he doing down at this end of the ward? Then, my nostrils are assaulted by the smell of smoke. I push the door to the bathroom open and it stinks - there isn't even a decent extractor fan to get rid of the smell. I write a note and secretly pass it to a nurse, pretending to pass her my laptop to be charged in the office. I scurry away down the corridor but she yells after me "tell XXXXX about the smoking in the toilet" waving the note, right in front of the guy I'm dobbing in. I cringe - does she not know that snitches get stitches?

Another nurse comes to our dorm and she starts accusing one of my dorm mates of smoking in the toilet. I leap to his defence. "Who was it?" she asks, and then bellows out his name when I whisper the answer. The fact that many of my fellow patients have a criminal past and have been in prison, does not seem to concern the staff members. Perhaps there aren't fights in here. Perhaps they never see any violence. Perhaps my fears are unfounded. Am I being paranoid?

The fire escape is padlocked shut, there are no fire extinguishers or sprinklers, the break-glass buttons are enclosed in plastic boxes that prevent the fire alarms from being set off - a fire in here would be catastrophic. Yet, I am certain that there are at least 2 cigarette lighters that are being used in my dorm. The patients smoke openly when the staff are doing their handover between shifts, when there's absolutely nobody around.

I make subtle enquiries with my fellow patients - how do they feel about the restrictions on smoking? Everybody agrees that the restriction on access to the outdoor area is more about control than it is about "promoting health" - they feel that the staff have created a system that allows them to exercise dominion over their inmates. "Smoke time!" demands one of the more aggressive patients, banging on the window of the office. "Calm down! Stop shouting!" yells back a staff member. This is an artificial and avoidable situation - why does it exist, when it's creating conflict between staff and patients, and making people stressed and unhappy?

When I was confined to the ward I would have made use of the outdoor area to walk around, get some fresh air and get some natural light. However, I couldn't get past the gaggle of smokers clustered around the top of the steps. To leave the door open all the time wouldn't create this ridiculous situation, where all the patients are fixated on this controlling aspect of their lives.

It's saddening, to see 19 men all hanging around waiting to be given a lighter and be let out, like they're animals; pets.

In defiance of the pointless draconian controlling bullshit, a handful of patients have smuggled cigarette lighters and tobacco into the ward - it's not hard when some patients are allowed unaccompanied leave from the ward. "Have you got any bottles or lighters on you?" a nurse asks me when I get back from an outing - I'm not breathalyzed or searched, even though I'm carrying a bulging bag.

I suppose the privilege of being allowed to leave the ward could be revoked, as a punishment for misbehaviour. The chance of being discharged early and allowed home is also under threat, for any patient who's troublesome. Most patients are here for a 6-month stay. It's up to 6 months, but it's more often longer, not shorter. The reaction to not being allowed to go home is rarely handled well - can you imagine that people who are unwell are able to remain calm and represent themselves clearly and articulately, when their liberty is at stake?

In terms of mental health, nothing could be more stressful, adversarial and paranoia-inducing, than having doctors and nurses discuss you behind your back, having been peeked at through the curtains every 15 minutes - patients are literally spied on and judged. Life, liberty and free-will are all interfered with in an institutional environment that's a cross between a prison and a school. Notices on the wall tell us they promote "independence and well-being" while also telling patients the very strict times that they need to be at the dispensary hatch to get their medications. At 8:54am I'm harassed by a nurse to go for my 9am meds... I'm well aware what the time is and also well aware that to be early is to be turned away empty handed. At 11:54am I'm harassed to go and stand in line for some food which is not even being served until 12 noon at the earliest, and is often delayed.

I'm aware that I'm lucky to have a sought-after psych bed - many people who are having a mental health crisis will have no access to inpatient care. To bite the hand that feeds me seems churlish, but I do feel sorry for my fellow patients who can't articulate their frustrations effectively.

The only patient I know to have attempted to file a complaint is the guy who's relentlessly trying to get 8mg more Subutex out of the doctors... unwilling to go along with the treatment that will wean him off his opiate addiction and quite determined to sabotage his recovery, perhaps.

Nobody's stopping smoking because of the "health promoting" rules around access to the outdoor area, but I'm certainly missing out on exercise and fresh air because of it.

It all looks rather counter-productive to me.

 

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Gone Fishin'

7 min read

This is a story about being observant...

ECG stickers

Where do blue tablets actually come from? Well, presumably they are pooped out by blue fish, like the ones that can be seen swimming here on the pavement and road. Can you see them - the little blue fishies?

With our Sherlock Holmes deerstalker hat on, puffing from our pipe, we might deduce from the proximity of a large hospital and the lack of water, that these are not actually fish. What could they be?

An electroencephalogram (EEG) is a graph of what's going on in our head, quite literally. En kephalé means "in head" in Greek, and the gram bit means "written down". Electro should be relatively self-explanatory.

Were these fish involved in seeing what was going on inside somebody's head? No, I don't think so.

An electrocardiogram (ECG) is a graph of our heartbeat, as denoted by the cardio part.

In order to know what our heart's doing, we are all very familiar with the stethoscope, but there's a more accurate test that doesn't depend on human hearing. The muscles that pump the 4 chambers of the heart never stop unless you go into cardiac arrest or otherwise die. Muscles give off tiny electrical impulses, and these can be measured with highly sensitive equipment - an ECG machine.

So what about these fish? Well, it looks like they're the little sticky electrodes that are put on each of your ankles, arms and across your chest around your heart. When you are hooked up to an ECG machine, you've got a stack of cables attached to you.

One of my fellow patients at the hospital was in such a big hurry to get rid of these stickers, after having the health of their heart measured, that they tore them off and discarded them onto the floor, quite possibly in a fit of rage at having been cared for by one of the finest healthcare systems in the world. It's quite understandable that having received lifesaving treatment that's free at the point of use, this individual should have ripped these electrodes off their body and tossed them onto the road and pavement - that'll teach society a lesson, now that a street sweeper will have to come along and clean up this trash!

We might note that there are only 4 stickers, and we can presume that these are the ones from the person's wrists and ankles, which would have been most conspicuous. Perhaps it wasn't until the person explored their body later, that they found 4 more on their chest - one of which was lurking around on their left hand side and might not even have been discovered until a later date.

Debate rages in the United Kingdom, about whether we should have penalties to discourage people from treating the National Health Service disrespectfully. We could charge people for a no-show to a General Practice (GP) or outpatient appointment. We could charge people for any visit to Accident & Emergency for trivial matters that could have been treated at a minor injuries clinic, or perhaps did not require medical attention at all.

There is evidence that we are starting to allow a two-tier society to emerge where none is supposed to exist. Doctors' waiting rooms have plush leather seats for 'VIP' patients - who are paying for private consultations - while the NHS patients sit on hard wooden chairs. For an operation, paying to go private might mean skipping waiting times, even though it will be the same surgical team, in the same hospital, with the same equipment and in the same operating theatre. Although it's not supposed to happen, surely some of the waiting times are because private patients are queue-jumping?

Those at the bottom struggle with zero-hours contract minimum wage jobs, with the purchasing power of their pay packet decreasing every month, due to inflation. Things are not a lot better on the next rung of the ladder - an NHS Clinical Support Worker's salary tops out at around £15,000. That's £259 a week. Ouch. My rent in London was £480 a week. The wealth disparity is disgusting, isn't it?

While the cost of housing and the cost of energy - electricity and gas - is skyrocketing with double-digit percentage increases, wages barely increase at all. One only needs to look at the use of food banks, to see that the little people are struggling - people who clean your toilet, scrub your floor, wipe your bum, cook your food, stack your shelves and scatter rose petals along the privileged path that you walk. But, these spoiled brats still vote for a ruling elite who care nothing for the wails of distress that are now becoming a deafening scream of pain.

The bulk of the BBC was moved up to Manchester a few years ago, and it's been quite evident that it's had an effect on the mindset of the people who work for the broadcaster. In London, the homelessness problem is inconspicuous in wealthy districts, but in Manchester - where homelessness has soared 1,100% in just 7 years - the problem is inescapable. The BBC has shown a number of documentaries which accurately reflect exactly what I have seen and experienced: there are vast numbers of people in dire need of assistance.

Who wants a McJob that doesn't even pay enough to be able to rent a room in a shit apartment, and have any life at all? Does it surprise you that people are smoking strong synthetic cannabinoids which allow them to escape the stress and hopelessness of a hideous reality that nobody in Government seems to want to address.

There's a crisis that's going on all around us. Pull back the covers and human tragedy is unfolding underneath.

This is not a "wake up sheeple!" alarmist or sensationalistic think-piece, but in actual fact an unfliching and painfully truthful account - I bear testament to what I've seen - of the shocking disparity between London and the South-East, where our wealth is concentrated, and the rest of the United Kingdom where things are very grim indeed.

We talk about the 'Westminster Bubble' and I can attest first hand what it's like. At the beginning of this year I was at the grand headquarters building of Her Majesty's Revenue Collectors (HMRC) and it had been refurbished to an incredibly high standard. I was taken to an extremely grand room, which was capacious enough to hold at least 50, maybe even 100 people, but only had me and the two people interviewing me. Otherwise this space was left empty and unused, so far as I could see - perhaps a metaphor for all the empty homes that have been bought by foreign investors in London.

Meanwhile, it was barely two years ago that I was in social housing apartment (council flat) in London, which was in such a poor state of repair that there was literally 2 inches of water that one had to paddle through, in order to use the toilet or a terrible shower that barely worked. It's quite clear where our tax money is going - tax breaks for millionaires, not houses for nurses.

Bursaries for nursing have now been removed, so our nurses will emerge with the best part of £60,000 of debt when they qualify, which will further reduce their take-home pay. The interest on a student loan of that magnitude is more than 12% of our nurses' starting salary of £22,000, which means they will sink deeper and deeper into debt each year.

Who will mop up your sick, piss, vomit, blood, mucous, pooh, give you a sponge-bath in bed, say soothing things and give you painkillers when you cry out in agony, come running when you press the call button and generally make you as comfortable as possible when you're unwell?

As comrade Corbyn said: a millionaire in their mansion is going to need an ambulance if they have a heart attack, just like anybody else.

 

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Congratulations!!! YOU ARE THE MILLIONTH VISITOR TO THIS WEBSITE

5 min read

This is a story about winning a prize...

Visitor stats

This week's big climber in the UK top 40 is a new single from the National Health Service. This band has been churning out smash hits since 1948 and is loved by tens of millions of fans. Here on Top of the Pops tonight, you'll see a live performance from this sensational act. Keep watching to find out what the UK's number one hit single is, at the end of the show.

Here on this page are the dry words of a deranged individual. How will you choose to interpret them?

Language is a rather crude and imprecise tool to fully express ourselves. Ambiguity creeps in and the thoughts and feelings of the author are not communicated with high fidelity - each reader will arrive at a different impression from the text.

As a software engineer who's been building systems for some of the world's biggest companies for over 20 years, I could easily copy Uber's dastardly tactics of diverting any web requests from a certain region of the country - e.g. a specific city in the North of England - in order to display a different page.

Most of my readers are using smartphones or tablets. Readers who are using Windows XP and Internet Explorer are quite unusual, and it's easy to flag up those anomalies - they stand out in the data that I gather about my visitors.

It's not hard for tech companies and technologists to present something that has been customised and tailored for each visitor. You might think that you'd see the same Google search results as somebody else, for example, given the same search terms, but Google works very hard to identify individuals, even in their anonymised dataset.

Traditional print-media widely reports that we are living in social media bubbles, where we are fed things that we like, because we're more likely to share that content and spread it 'virally'. What is less well reported is how wedded we are to the walled gardens that we live in - Facebook, Twitter, Instagram, Snapchat et. al.

How long are you going to keep reading for? There's nearly 700,000 words here. Are you gonna read it all?

The best defence against anybody who would seek to jump to the wrong conclusions and make silly assumptions, is to present more data than can be reasonably processed - information overload - such that the farcical nature of reducing the complexities of life to some pathetic synopsis, are exposed as pure stupidity.

Of course, we would all love to feel that we understand all the laws of the universe. I've fried my mind with stacks of books and papers on theoretical physics, attempting to understand the fundamental nature of reality itself. Emotionally, I don't want to admit defeat, but digging deeper only seems to reveal even more unfathomable weirdness. Some of the quarks are called strange, charm and beauty. I love that.

Are you bored yet?

Can you not see that my intention is to create a maze of complexity that's impenetrable? It's not possible to know my mind. Even for me, I struggle to understand fully why I say and do the things I do. If it's hard for me, it's going to be impossible for you to dissect or categorise me; to judge me and to simplify me into something that can be captured by written language on a sheet of paper. What are you going to write in your report or your email?

There's mockery and disdain here, but if you dig a little deeper I hope you see that I don't have disrespect for anybody whose intention is to help and support me, and I have no intention of damaging my own treatment and recovery, nor anybody else's, nor cause any difficulty for the hard-working staff of the National Health Service and the ancillary support services.

Today, I'm a free man - an informal patient - but that puts me in an additionally vulnerable situation. I could be discharged from the hospital without a discharge plan - no place to live and no income. I'm sure some pen-pusher somewhere sees the opportunity for a quick win - am I just a statistic on a monthly report?

Tories out

It upsets me that front-line staff have been cut, while middle managers have plenty of time on their hands to justify their pointless existence. The managers have survived the cull, the pay freeze and the excessive demands placed on the over-stretched people who actually do the damn job. Police, NHS workers, teachers - to name but a few - are getting a bum rap.

The first thing that I'm excited about doing with my newfound freedom is going to a protest at Tory cuts and austerity, to co-incide with the start of the Conservative Party conference, in a certain Northern city. The establishment are coming to me, and I will thumb my nose at them and boo them. A friend suggested that I could throw eggs and if I got in trouble with the police, they'd probably just bring me back to hospital on a section 136... put that in your damn report.

"Risk to the community - possibly going to throw eggs at Theresa May, to protest against cuts to front-line services and damage to the NHS, as well as undue stress on the police and other workers who care for and protect our most vulnerable members of society".

 

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Two Contrasting Weeks

17 min read

This is a story about comfort zones...

Montage

Relax and put your feet up, I'm about to tell you the tale of two sedentary situations.

I'm institutionalised. Put me inside a hospital or a head office, and I'll feel right at home.

Most people don't like hospitals: they associate them with pain, death and stress. Most people don't find hospital relaxing; quite the opposite in fact. Hospitals are places of mysterious rhythms and routines that seem chaotic to most people. There are different sounds that all the machines make when they're working, and when they're making noises that indicate that something is going wrong. There are different NHS staff, in different roles, in different clothes, who appear at different times.

My week in hospital that I'm going to tell you about - although I spent the best part of two weeks in hospital  - sounds kinda nice, because I was never really afraid or outside my comfort zone. I find the functioning of complex organisations to be fascinating. I love observing the systems and the people, trying to second-guess what's going to happen next, and what's going on behind the scenes. I like asking loads of questions and adding whatever I can learn to my growing body of knowledge that allows me to feel more in control of my destiny and more able to know what to expect next, than the tense, anxious and extremely tedious waiting game that most patients face on the National Health Service.

Once one has resigned oneself to the maximum speed that a massive organisation can function at, the whole hospital experience becomes quite meditative. Sitting in Accident & Emergency, you can fill your time sneakily looking at the other patients in the waiting room, and trying to guess what symptoms they reported to the reception staff when they arrived. Shortness of breath, chest pains, numbness in one side, drooped face, earlier seizures, unconscious or otherwise delirious patients will normally arrive by ambulance, but any walk-in presentations will obviously jump to the front of the queue. Then, there are the people with minor injuries who have put up with their trivial ailments for days or even weeks. The reception staff aren't allowed to tell them to fuck off, so these idiots must sit for hours on end, only to be told off for wasting valuable NHS resources, quite rightly. In the middle, there are nasty workplace injuries, DIY accidents and total wildcards. You usually get seen by a triage nurse within an hour.

Having been admitted into Accident and Emergency, there is a brief flurry of activity while routine blood samples are taken, and perhaps you're hooked up to a drip. A barrage of questions is fired at you. Examinations seem to be probing and thorough. Surely these professionals are going to have this problem fixed in no time?

It's always a mistake to believe that important things are happening and it won't be long before the right diagnosis is reached and the right treatment is administered. One should be aware that the function of A&E is to rapidly assess whether you're about to die, whether you might need to be properly admitted to the hospital, or whether you can be discharged swiftly, suddenly and brutally.

Once on a ward, a certain amount of orientation and induction is necessary, but all wards function with great similarity. All nurses are grateful if you don't press the call button all the time, for trivial things, as well as being cantankerous and discourteous. Remembering one's Ps and Qs at all times is a pleasant distraction from boredom, pain and discomfort. There will be shifts, and it's important to be mindful of when these shift changes occur. The NHS staff see so many patients come and go, and many are lucky enough to only have a very short stay in hospital, so there will be a certain initial reluctance to absorb you into the system: the ward wants to spit you out undigested.

Having overcome some initial resistance, you can relax into hospital life. Your day begins with your vital signs being measured. Then blood samples are taken. Then there is the hullabaloo of breakfast, ridiculously early in the morning at 7am. Then, there is nothing. All of that disturbance keeps the night shift staff briefly busy before they hand over to the day shift. The day shift hope to be able to ease their way into the working day gradually. Consultants start to appear at around 10:30am, followed by a gaggle of registrars and junior doctors. The most important time of the day arrives: choosing your lunch and dinner for the next day. By the time that lunch is served, you can't remember what you're going to get because it wasn't long ago you had to choose what to eat tomorrow. The meals are pleasantly bland and easy enough to eat. Mealtimes are something to look forward to, even if the food is far from gourmet. Expecting much to happen during the day, in terms of treatment, is a mistake. Anticipation of treatment that has been promised can only lead to frustration and disappointment. The NHS does what the NHS does, and it does it at its own speed. Things cannot be rushed or expedited. Complaining or asking staff when things are going to happen or what's going on, will only piss them off and ruin their day. Dinner arrives surprisingly early. Treatment can be sprung upon you at the end of the day, just when you thought you were going to have a relaxing evening, or you can have a lengthy wait until you get your pain medication and anything to help you sleep. Dropping off to sleep is not easy, especially as the day shift will hand over to the night shift loudly at the end of your bed, and there will be more vital signs being measured before you'll be left in peace to try to get some rest.

And so, my week in hospital consisted of lying on a bed that had buttons that could make me sit up or lie down, with no effort required at all. I was able to elevate my bad leg, to reduce the swelling. I was brought paracetamol every 4 hours, tramadol every 6 hours, and 2 hot meals a day. There were few unexpected interruptions, and if I was well enough, I would have been able to read, listen to music, browse the internet and watch films & TV, pretty much all day, all evening and as late at night as I wanted. I could stake a piss without even having to get out of bed. Friends travelled to see me. Doctors came to my bedside, and I was wheeled to wherever I needed treatment, by hospital porters. I was under no obligation to do anything, except to get better, and all my basic needs were met. My lovely girlfriend augmented the hospital care, so I wanted for absolutely nothing. Blissful, right? I could have stayed for a month, and I would have even earned £676 (I pay myself minimum wage).

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Why then was I in such a hurry to discharge myself? Why would I leave the lap of luxury, and risk my health and even my life, by leaving the safe confines of hospital?

Well, that's a topic of discussion I've covered at length in prior blog posts, so I invite you to peruse the archives.

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People rarely change their bank. We open current accounts in our teens, and we keep them into adulthood. Some of us even opened special accounts when we were children, and we have a certain nostalgic brand loyalty for the bank that we've been a customer of since we were youths.

The 'big four' or 'big five' high-street banks have not changed for my entire lifetime. We have (in alphabetical order) Barclays, HSBC [Midland], Lloyds [TSB], Royal Bank of Scotland and Santander [Abbey National]. These banks hoover up 85% of all the current account banking customers in the UK.

Just like current account holders, people join these banks when they're young - often their first job - and tend to stay loyal. Many people who I deal with on a day-to-day basis have worked for 15, 20 or 25+ years for the same bank that's been so good to them that they've never felt compelled to leave. Everybody bitches about their job, but a bank employee knows that they're very well looked after and they'd be mad to go off in search of a better job.

I've worked for 3 of the big 5, and they're institutions that I feel very at home in. Some people might think that I work in a rather high-stress environment, where it's imperative that I'm up to date with the latest cutting-edge developments in my field, and I need to perform in an exceptionally demanding role. The truth is, once you're in the door, you're in for good. You get your feet under the desk, and adopt the right kind of jaded resignation, that everything is going to be slow, sloppy, shit and a massive festering pile of neglected crap that nobody gives two fucks about, and you'll fit in just fine. Moan as much as you want - everybody does - but for God's sake don't go on any crusades to change or improve anything. Just settle in, get comfortable and enjoy the masochistic experience of being in a world where not a lot gets done and the right answer is always "no".

A lot of people get into technology and engineering, because they like to fix things and make stuff that works. They like to build stuff. They like the feeling of completing a technical project, throwing the switch and seeing their hard work put into action. A bank is a terrible, terrible place to build anything that will ever see daylight.

Having come to terms with the fact that any ambitions you had of building useful things that people might actually use, will be forever thwarted by a bank, you can begin to enjoy the ridiculous game. You command millions of pounds of budget, and you will achieve nothing. When you estimate how long you think it will take you to do something, you double your original estimate, double it again, and then double it one final time for good luck, and it's still not long enough. When you are asked about the feasibility of doing something, or whether you have any spare bandwidth to perhaps do something extra, you instinctively say no; it can't be done; no chance. Nobody ever got fired for saying no. In fact, people start to love you and think you're great at your job, if you get really good at saying no.

Delivering pieces of important technology, 100% working and of high quality, in short timescales and with hardly any resources, is liable to cost you your sanity. "It can't be true" colleagues will proclaim, even as the results are staring them in the face. From denial, your colleagues will move to the belief that it's a one-off fluke, or they will hate you. Colleagues will mainly hate you for making them look like totally incompetent blundering slowcoach fools. Nobody ever made friends and got ahead in a bank, by doing a good job. Finding yourself burnt out from the exertions of persuading people of the merits of doing things properly, without pointless delays, you find yourself suddenly alone; isolated. You may create some kind of mythical; legendary; cult status around yourself and your achievements, but you have no future with the bank: the bank doesn't want your type, and it will unceremoniously eject you.

You can work for a bank for as long as you like, provided you just go along with things. Never challenge anything. Never push for change. Never go the extra mile. For sure, banking demands that you be seen to be going the extra mile, but it's all just for show; part of the act.

So, if you want to be really successful in your banking career, you learn the rhythm and routine of your department. You learn when your boss arrives at work, and you get to your desk before him or her, and leave with them in the evening, making pathetic small-talk. You learn who's got kids, what ages they are, and what stressful childcare arrangements are a pain in the arse for your colleagues. You learn how everybody gets to work. You learn whether they're morning people or night owls. You learn their interests: topics to get them talking; things that enthuse them. You learn who takes their job seriously; who's ambitious; who's jaded and demotivated. You learn who drinks heavily, smokes, gets stoned. You learn who's lived, and who's been insulated. You learn who's worked hard, and who's had advantages. You learn when to make yourself scarce and blend into the background, and when to promote yourself. You learn the things that need to regularly get done, and you discover many things that don't need doing. You learn how to do just enough to please the handful of important and influential people, and how to avoid having to do any pointless busywork.

You can't prepare yourself for boredom. There is nothing in the world worse than boredom.

My first week back in the office was 4 days of boredom. I've seen it all before, done it all before, and I'm the master of minimal effort. The only problem is that I need to look busy to make a good first impression. I forbade myself from reading the news on my laptop. I tried really hard to not look at my phone too much, and to pretend to be busy.

My boss and his boss, both sit right next to me. My boss is a nice guy who seems to have a paternal nature. The big boss talks too much and doesn't realise that I find him amusingly stupid. I listen, make the right noises and say some encouraging sounding things, but I'm completely failing to disguise my contempt for this fellow, but luckily he's the only one who fails to see my total lack of respect for him, except for my bosss. I endeavour to make my boss feel that my number one priority is in supporting him in making our team look good in the eyes of the big boss. I try to make the big boss feel in control, while diverting any respect he commanded away from him. There's a mutiny in progress, but nobody will realise until it's past the point of no return.

Virtually nothing can be achieved in 4 days in a bank, and I've achieved far more than anybody expects of me, even though I've spent a considerable amount of time in the toilets, browsing Facebook and writing amusing things for my friends to read. I invested as much time as I possibly could in developing a good relationship with my boss and my team, but I have nothing of value to contribute yet. Aside from dazzling my colleagues with my all-round technical knowledge, my main task is to stay the fuck out of their way and not disrupt things too much.

Regrettably, I've had to take Friday off work. Making a good first impression can only be done once, and the lasting image that my colleagues will have of me - the guy wearing the robocop ankle splint - will now be tainted with the fact that I had to take time off work, giving the impression that I'm unreliable and prone to sickness. Damage to your image like that can be irreparable.

Sometimes, it's desirable to be known for being unhelpful, regularly late to work and somebody who leaves on time in the evenings. Being somebody who walks out the office door, even when there's a major crisis, is the sign that you have become perfectly adjusted to bank culture. However, the clever ploy is to try hard at first, to develop an image of being a hard worker, but in actuality, you are avoiding work and responsibilities at all costs. In time, you will have the best of both worlds: being thought of as dedicated and useful, but actually adding no value at all.

My foot has been steadily getting more and more painful through the week, and I've been popping painkillers throughout the day. I've passed the week in a dreamlike state; heavily medicated. Having strong coffee in the morning to make me sharp and alert enough to make a good first impression, has meant that I've been able to stay awake in some horribly boring meetings, but it has made me a little hypomanic, causing me to be far too outspoken at times, but I think I've got away with it.

I've earned more in a single day in the office, than I would for almost a whole month of being in hospital. That kind of cash does motivate you to get out of bed in the morning, and to stay at your desk with your mouth shut, when really you can't stand being in the office.

You'd think it wouldn't be that hard, being a bit bored, going to a few meetings, talking to people, saying fairly standard things that are obvious. Having the exhaustion of being unwell, plus being in pain and discomfort, make things hard for sure, but in a way, it's been an excuse to be fucked up on drugs for 4 days and get paid an obscene amount of money for the privilege.

It seems fairly clear that if I can dial the intensity down to 4 or 5 from 11 - and the dial only goes to 10 - and ease my way into a gentle routine that I can just about cope with, then I'll be able to blend in for years. There's no reason why I wouldn't be liked and respected. There's no reason why I can't be perceived as doing a great job, even though I'm not doing anything useful. That's the main thing I need to remember: I'm specifically there to not do anything.

Saying the right thing at the right moment - being the smartest guy in the room (as someone I know once jibed) - comes easily to me, and it does unfortunately command a disproportionate amount of respect versus doing some real work instead.

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I'm not sure which week was more comfortable. Certainly hospital was more physically comfortable, but I was highly stressed about losing my lucrative hard-won contract and being too tired to be able to function when I started work. My job is extremely easy and I anticipate no problems, except coping with boredom and my propensity to blow a fuse with frustration at the snail-like pace that everything moves at.

Sleeping in my own bed has been far superior to the hospital bed, but getting up in the morning is never pleasant. However, my lie-ins were so ruined in hospital - by irritatingly early breakfast and the like - that I have actually been getting ready for work, relatively painlessly.

Commuting is hell, but because I know it's hell, I'm able to impassively observe the shit that I'm going through; detach. Commuting is the price that one must pay, if you wish for your gross income to exceed a year's average salary in the space of just 8 weeks.

How can anybody handle such contrast? It's insane. It's surreal.

How can I walk out of a hospital, against medical advice, and go straight into a brand new job where they're oblivious of just how sick I am and how messed up my brain is by strong medication? Can't they see that they have an imposter in their mix? Obviously not.

That, effectively, sums up the bipolarity of my life. The ups and the downs. The highs and the lows. What more extreme example could I come up with?

 

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