Hypomania in the Royal Ed

In June 1990, I was admitted to Ward 1A of the Royal Ed, my bipolar swings having soared into hypomania. My family had been increasingly concerned by my erratic behaviour; a consultation with a psychiatrist confirmed their fears I was broaching mania, at the dangerous top end of the bipolar mood scale.

​The graph produced by Bipolar UK (below) is not meant to be definitive, but is an indicator of possible behaviours. A copy can be downloaded from the Bipolar UK website and used as a 'mood diary' for anyone with bipolar tendencies "to help keep track of your moods and to help you spot your patterns, triggers and any early warning signs of a relapse."

​Abridged excerpts from my Royal Edinburgh Hospital records. 15-17 June.

Thursday 14/6 - Friday 15/6
Close observation continued. Restless. Medication at 12:30 AM. Largactil 100 mg. Settled and slept.

Friday 15/6
Slept until 8:30 AM. Slightly restless on occasion. When asked a question appears anxious to answer then get on with something else. Appears to be interacting reasonably well with fellow patients. Urine specimen to be obtained for clinical chemistry drug scan.

PM
Still appears disorganised at times. Placing his state of health upon the fact that he's wearing the colour red and is therefore protected from a further breakdown. Thought process appeared jumbled at times. Close observation continued. Restless. Largactil 100 mg given 12:15 AM. Did not settle till after 2:00 AM.

Saturday 16/6
Remains rather disorganised, thought content jumbled at times and dominated by themes of WWII/Nazis and the colour red he believes can cure him if he touches it. PRN 100 mg chlorpromazine given 12:20 PM in order to clarify his thought content.

PM
Mark appears to have had a reasonably settled day, despite having clear difficulty in concentrating and being unable to sit still for any length of time. Did however sit for a period to do some writing. Speech content remains confused and disordered. During conversation becomes easily distracted, moving from subject to subject in response to stimuli. Visited by parents, expressing further concern about son's mental health. Out 2 x escorted by myself for short walks. Mark's conversation focussed mainly on drug abuse and the issue of child abuse. Said the last time he took drugs was 10/6/90 following a church service. Described his reaction to the drug (cannabis) as 'a downer.' Talked also of the colour red and how touching something red can ward off bad feelings and showed me a red object he was holding in his pocket. Mark remains on close observation due to risk of unpredictable behaviour.

Saturday 16/6 - Sunday 17/6
Close observation continued. Restless. Largactil 200 mg given 12:40 AM with no effect. Restless. In and out of bed. Largactil 100 mg given 02:30 AM. Did not sleep until 04:30 AM.

NOTES:

PRN: pro re nata. Medication issued when required, over and above daily dosage.

Largactil: a brand name for chlorpromazine, an anti-psychotic drug commonly used in the treatment of schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, and other conditions. One property of this medication is that it can work as a 'dopamine antagonist,' blocking dopamine from activating certain types of cells in your brain and body, slowing down the activity those cells control. Side-effects include dry mouth, movement problems, low blood pressure upon standing, sleepiness, and increased weight. Patients have nicknamed chlorpromazine 'the chemical straitjacket.' In one chapter of my mental health memoir, 1976 - Growing Up Bipolar, entitled 'Pills 'N' Thrills And Straitjackets,' I paint a graphic picture of what happened when I was an outpatient, mixed chlorpromazine tablets with copious alcohol, then headed into a Lothian Road nightclub, The Amphitheatre.

Thought process: my obsession with the colour red goes back to the time I crashed to zero on the bipolar scale in 1987. In the back of an ambulance, delusions whirling, I spotted a red light. A brainwave: saying the word ‘red’ aloud would wake me from what I assumed was a weird, horrific nightmare. But the paramedics had injected me with a strong sedative, so I couldn’t even open my mouth, far less try using some magical password.

Heading towards 10 in the summer of 1990, when I felt my hypomania rising, my deluded imagination thought touching anything red would bring me back down. On one occasion I discovered a Lego set in the ward. Mind racing, I started using the bricks to construct the flags of any of the countries in the current World Cup tournament containing red: Austria, Romania, Spain, Costa Rica (who, ignominiously, beat Scotland 1-0), England, and West Germany (the eventual winners!)