spinofflive
Illustrations by Austin Milne
Illustrations by Austin Milne

The Sunday EssayFebruary 4, 2024

The Sunday Essay: Laughing with the mania

Illustrations by Austin Milne
Illustrations by Austin Milne

Years of researching health psychology didn’t prepare Alice Black for her own stay in an acute mental health ward.

The Sunday Essay is made possible thanks to the support of Creative New Zealand.

Illustrations by Austin Milne.


Disclaimer: Memory is fallible at the best of times, but my memory of hospital is distorted by the experience of mania. This is what I remember. I cannot guarantee it. 

‘You leave your dignity at the door when you enter a psychiatric hospital or you give birth and pick it up again on the way out.” These were my mum’s words of comfort when I complained about my experience at Te Whare o Matairangi, a 24-hour mental health assessment and treatment service, after being hospitalised for my first manic episode in mid-2023.

I have a MSc in health psychology and a background in mental health research. I thought I knew a little bit about the system. It quickly became apparent, however, that I had no idea just how grim a place an acute mental health ward really is.

In the first ward I was in, my room simply consisted of a mattress on the floor. There were frequent visits by security staff and there was a general climate of fear. After I was moved to another ward, I commented to a staff member that my experience in the previous ward had been worse than being treated like a dog on the street. They justified the mattress on the floor with some vague reference to safety. There was nothing much else to say.

I was initially restrained and given injections by force. I wondered, as I was lying on the ground with my limbs pinned down, how any of this could be legal in Aotearoa in 2023. At one point I had my boots confiscated for kicking the staff while I was being restrained. Unlike most of my memories of the hospital, this one makes me smile.

I’m what people refer to as a “strong woman”. I used those words to describe a relative at her funeral and it was a euphemism for “cruel and borderline psychopathic”. I don’t think I’m either of those things, but I am blunt, and I haven’t genuinely respected authority figures since I was in primary school. But regardless of your personality, I think being trapped in a mental health ward against your will would test anyone’s interest in compliance.

I’m not a violent person, but I do have a Tony Soprano complex, I see Malcolm X as a social justice hero, and I think guerrilla warfare IRA-style is morally sound. Malcolm X once said, “Be peaceful, be courteous, obey the law, respect everyone; but if someone puts his hand on you, send him to the cemetery.” Manic or otherwise, nobody was going to touch me without my consent. Long story short, my psychiatrist eventually gave up on the injections and I got my boots back.

A couple of years ago, I co-authored a paper on men’s experiences of mental health stigma. Suddenly I was having compulsory treatment under the Mental Health Act in the immediate vicinity of my former employer. I don’t think there are many things more stigmatising than being committed in a psychiatric hospital. It was a waking nightmare. Even while I was manic, I was aware of a bitter irony. My former employer published a large review of acute mental health settings and found them to be places of terror and violence. They found service users lacked autonomy and a sense of care, experienced an atmosphere of paternalism and boredom, and felt physical confinement and lack of activities contributed to violence on the ward. I was now one of those service users.

I’ve been back home for a while now, but the power dynamic is ongoing. I have to attend reviews – I’ve been referring to my monthly engagements with the community mental health team as my “parole meetings”. Despite the team’s attempt to build a therapeutic relationship with me I find the meetings, by virtue of their compulsory nature and stressful content, extremely unpleasant and they usually bring my mood down for days afterwards

I’ve been relieved to find I share a common experience with others, but also saddened to find what happened to me is not unique.The He Ara Oranga inquiry of 2018 found the current Mental Health Act to be outdated and coercive.They recommended that the government adopt a human rights-based approach, one that prioritises shared decision-making and minimises coercive treatment. It’s heartening to know that the MHA is under reform, but it’s ultimately not going to make a difference unless the hospital’s physical (custodial) environment also changes. It is a self-fulfilling prophecy to put people in an environment that so closely mirrors a prison and then call security on them when they (so predictably) lash out, as I witnessed numerous times.

After the injection failed and the medication wasn’t working, I was given electroconvulsive therapy (ECT). It was terrifying at the time, but it’s ultimately a pretty standard (and highly effective) procedure and I would have it again if I was experiencing symptoms. However the context in which I received ECT was less than ideal.They initially anaesthetised me on a hospital bed in front of the entire ward and I was surrounded by students. It was humiliating and degrading. I had no idea what was happening and thought I was having an EEG.

When I finally realised what was going on, I was mortified. I told my psychiatrist I didn’t remember giving consent and he said that that was because I didn’t. The opinions of two psychiatrists overrode my say in the matter. I’d never experienced such an abject loss of power. It reminded me of how Janet Frame was almost given a lobotomy before she won a prestigious writing award. Now that I’m doing better, I can see that the severity of my symptoms warranted ECT, but that doesn’t make the complete disregard of my agency any more palatable. Contra Janet Frame’s near miss I think having had ECT will ultimately help with my writing aspirations – I just want to be like Joe Bennett by the time I’m middle aged okay, if that’s delusional then I guess send me back to the ward.

Comedy about hospitalisation and mania helps me process the distress I experienced. There’s an episode of Peep Show where Jeremy and Hans try to get Mark sectioned, for example.

I also listened to a lot of Kanye West, the poster boy for bipolar, in hospital. And, of coming out of my manic episode I would simply say, “Bitch I’m back out my coma”. 

Comedy normalises my experience and I’m so grateful to live in an era where bipolar memes and reels are available. 

 

After I got out of hospital, my favourite message came from a good friend and former flatmate. I couldn’t remember what he knew so I just said that I had had a pretty rough few months, but I was getting better.

He replied:

“Oh shit! Sorry to hear about how mental you are! Always thought you were a bit of a lunatic. Just joking…obviously a serious thing. Just wanted to see if you still had your sense of humour?”

It was exactly the response I needed. My friend Áine similarly reflected: “Hard yards make hard cunts.” Humour is the antithesis of trauma. It is my peace.  

Mania is terrifying, by the way. I’ve heard people talk about the “high” as being enjoyable because you can feel confident and charismatic. Well, I normally feel confident and I can be fairly charismatic when required (e.g. shortly after being discharged, I confidently [and insanely] gave Aragorn’s Black Gate Speech at my brother’s wedding). However, at no point when I was manic did I feel “good”. I felt terrified and paranoid and when I was in hospital, I thought I was going to die.  I was caught up in a number of delusions that no one could reason with (see below), and I couldn’t tell what was real or who I could trust. There was no escape.

One of  the symptoms of my mania was that I became completely fixated on a hospitality worker that I had previously simply had a crush on. I normally form crushes on pretty much every barista, bartender, supermarket checkout operator and Bunnings employee that I meet. I love to flirt and I hate to follow through (you can’t be let down if you never actually get to know someone!). 

This particular delusion persisted throughout my stay in hospital and even after I got home it took me a while to put together what had happened and accept it wasn’t real. Having to let go of the reality I built up around this person while I was unwell was more gutting than any “real” break up I’ve ever had. Partly that’s a testament to the mediocre men I’ve dated (not all of you, please don’t message me), but partly it’s just the fact that what was a delusion by DSMV standards was still real to me at the time. It no longer feels sad, I can accept it as a symptom I had no control over. But it does feel mildly embarrassing because regular Alice would never put a man (except one of my many wholesome middle-aged role models) on a pedestal. Regular Alice very quickly writes off almost all the men she encounters and then wonders why she is single.

The worst part of the whole experience was the boredom; being isolated from my friends was a close second. I actually missed work, or more accurately, I missed the 30 coffees a day I have with my friends while at work.  Everyone determined that I was at too great a risk of damaging my reputation so I had my phone and laptop taken away from me and I was given what I can only describe as a “burner phone” with the numbers of five close friends. As a raging extrovert who is in constant communication with all her close friends and family, I found this part unbearable. I also couldn’t listen to comedy (which I can confidently say is my primary coping mechanism). Thank you to Scottish comedian Limmy and my favourite podcast, Uhh Yeah Dude for keeping me “sane” (I’m still mental, just in a more socially acceptable way) when I finally did make it out of hospital.

My family and close friends have been incredibly supportive and caring. I’ve received flowers, coffees, homemade scones, books and magazines, kind messages, visits, a trip to Kapiti Island, and most importantly, unconditional love and support.

There is nothing like a crisis to tell you who your real friends are, however. A few friends distanced themselves from me after I got out of hospital. Two people actually ended an eight-year long friendship and a couple more have stopped talking to me but bizarrely still watch the odd social media story. It would be nice and #wholesome if I could be accepting and forgiving of all of that. But unfortunately, in peace times I am a vindictive bitch. So to the people who peaced out while I was at my most vulnerable, I say what Malcolm Tucker said to his former colleague in The Thick of It:”Sorry you had to go but let’s face it you are a fucking waste of skin.” Mania is something I experienced for the first time at 31. I couldn’t have predicted it and it’s not something I’m going to feel guilty about.

The article by my former employer concludes with a question around whether mental health facilities are places of healing or of custody. I had a great psychiatrist, the support of my family, and eventually the right treatment. But being in an acute mental health ward under the Mental Health Act felt like being in a violent relationship, one I Iegally could not escape. Bring on the reform.

‘Hutt Valley, Kāpiti, down to the south coast. Our Wellington coverage is powered by members.’
Joel MacManus
— Wellington editor
Keep going!
Illustration by Little Rain
Illustration by Little Rain

The Best OfJanuary 28, 2024

I hate the Barbie movie, and it’s because I’m 44

Illustration by Little Rain
Illustration by Little Rain

I now understand why crisis and midlife go hand in hand. For the first time in my life, I feel like there might be more behind me, than in front. 

The Sunday Essay is made possible thanks to the support of Creative New Zealand.

Illustrations by Little Rain.


I watched the jug clunk onto the kitchen floor and split quite perfectly into two pieces. I was flooded with sensational relief. Then molten rage surfed that surge and was expelled from all of the places I’d felt it metastasising inside my body that day.

It wasn’t my fault. The kitchen cupboards are too small, configured by someone who doesn’t cook or own a tortilla press.    

I hadn’t dropped the stupid jug from a great height myself, but I knew that my rough rummaging to find the grater in an overflowing cupboard might result in something breaking. I’ve smashed crockery deliberately twice in my life, and the surprisingly physical sensation of release isn’t one you forget. There’s an instant drop in pressure, a cool nightfall after a constricting humidity and a shocking silence in which your anger can no longer be loud.

In the early months of 2023, I regularly found myself profoundly and suddenly irritated with an insatiable urge to break plates and jugs in order to reach the silent aftermath. Everything irritated me in ways that weren’t fair. People who didn’t indicate while driving were monstrous, and this common lack of driving etiquette spawned anxious ruminations about civilised society. 

Catching sight of a shirt hanging in my wardrobe without its top button done up would unravel a tightly wound spool of yarn that quickly knitted itself into a blanket of irrational rage that lay heavy over the day. Picking up a slimy and unrinsed kitchen cloth would nick the tight and tough skin that bound all the vital parts of my good and strong marriage together and tear wider to expose a catastrophic injury only I could see. I would point at this wound, and my husband – trying his very best to peer past what was obviously small and stupid – would become increasingly bewildered. His hurt at becoming the target of another flash flood of rage was far more real than the imagined injury I saw, but I had no way to tend to it. I would skulk about mute because I didn’t know how to explain myself, and he would start doing things. My husband is a good man whose default setting is to assume he’s done something wrong and then load the dishwasher. 

Growing up, my school reports always contained a variation of “Anna is bright but talks too much”. My teachers exhausted every synonym for talkative, exceeding expectations one year with “garrulous”. Being unable to use words to explain why I was so angry as an adult was a malfunction of my default setting. 

Over my life, I have assembled the reports and observations others have made about who I am and turned them into a neat collage of character. I have pasted down the ragged edges and created a discard pile to bury away out of sight. Bright meant intelligent, intelligent meant logical, logical meant rational and rational meant contained.  I sort the events of each day into tidy piles, put a lid on the things that I assess as “me” problems so they don’t leak out and allocate emotional responses like a judge dispensing sentences, confident in my own common law. I assume everyone’s impression of me is a manifestation of my tidy mind, and any spills are controlled, and leaks are quickly mopped up. Last year, the lid came off, and I had no idea why. The irrational and profound irritation and the floods of rage were chased by shame about my lack of control.  When the rage dissipated, and my husband and I would try to pull out the fragments that had lodged after each explosion, I circled the events like an observer investigating a blast site. I knew what was going on because I was there, but I felt like an outsider, making assessments without the benefit of being present. 

After a few of these explosions, I did what anyone does when confronted with unexpected behaviour, patches of dry and itchy skin and an inability to sleep past 3am, and tried to diagnose myself. The “age, woman, rage” google search deviates from the norm but is startlingly homogenous. You don’t have cancer; you’re just a woman who’s getting old.  

The results are a bland buffet of rapidly growing awareness.  Menopause is all the rage. “Why You May Want to Break Things During Perimenopause”, “Why So Angry? Discover Why Women Get So Fired Up in Midlife, and How to Control the Rage”, “The Emotional Roller Coaster of Menopause”. I clicked on all of them, reading every word. 

I should have felt grateful for this wellspring of information because knowledge is power and women’s health is neglected and I’m a feminist, but in my head, the word menopause takes on the same quality as Eeyore. It sags like the skin above my knees and droops like the skin above my eyes.  

I hate the phrase “it’s hormonal”. The body is full of mystery, but nothing seems more mysterious to me than hormones. They could be pixie dust for all I have known about them. Knowledge, in this instance, is depressing. I could name what was happening to me, which helped a bit but did nothing to quell the indignity of having my carefully constructed self undone by an invisible and molecular product of my own making.

At age 12, I was armed with information about the pituitary gland and the impending impact of its hormonal harbingers of doom. My first period arrived on the morning of my first swimming sports at school. I spent the morning panicking about how to put in a tampon. I wasn’t repulsed or embarrassed. I was angry that this thing would happen every month and derail carefully laid plans. Years of “battling”, “struggling with”, and “managing” my weight would frequently be explained to me by doctors as having something to do with hormones. 

When I had gastric bypass surgery in 2020, I tried to force the anesthetist to explain why I didn’t need to take medication for type 2 diabetes any more. He’d just drugged me for the surgery and wasn’t the correct expert to ask, but the word “hormones” is one of the few that made it through the anesthetic haze and into my own mumbled explanation to others in the months that followed.  

After 30 years of something happening every month and incomplete but plausible explanations about why you were battling your own body, you have to make some peace with it. Premenstrual moods become notes in a calendar, and the science of weight gain and loss at least gave me a framework for being fat. My discomfort about what Zadie Smith describes as being “tied to my ‘nature’, to my animal body – to the whole simian realm of instinct” shrank, becoming a manageable lump of recurrent disdain. My tidy mind catalogued it and put a lid on it.

Perimenopause feels like a betrayal of that accord. A mind untidied by a mysterious vulnerability.  Worse still is that it doesn’t come with the neat monthly schedule of a menstrual cycle. The irritation and rage seemed to rise and fall with no discernible rhythm. I couldn’t plan for it. When being logical and “intelligent” is the crutch you’ve leaned on in the face of having a body that didn’t conform to any outwardly useful ideal, the pathologisation of the loss of rationality is frustratingly anti-intellectual. My ability to rationalise things has always felt like a source of agency, and now a sneaky little thief had turned up to rob me of it. 

I turned 44 in August last year. My father called me on my birthday. “Welcome to middle age,” he said. It sounds stupid now, but that was the first time I realised I was, quite precisely, middle-aged. I have never thought of any age as bearing inevitability and wasn’t prepared to be struck between the eyes by this one. 

“Because I’m 44” became an explanation, an obsession, an excuse and a joke at the office. If I was irrationally grumpy about something, it was because I was 44. If I didn’t know who my younger colleagues were talking about, it was because I was 44. I spent a week proudly and deliberately telling everyone I didn’t know who Olivia Rodrigo was “because I was 44”. My colleagues would repeat the refrain back to me as a question. “Is this because you’re 44?” they’d ask as I muttered about yet another pop culture moment that had passed me by. 

Perimenopause and its banal but inescapable realities gave my age a hard truth, but something else was eating away at me. Something that felt divorced from the explanations of why the bouts of sudden rage were happening.  Something that was slowly churning rather than rapidly boiling.

One of my angriest obsessions last year was the Barbie movie. I haven’t seen it, but I hate it. Wrapped in a big pink bow was the nagging feeling that my anger and confusion weren’t just pathological but something more existential. 

As a kid with a mum who wanted her daughter to value more than her appearance, Barbie was banned. The feminist canon I spent my twenties immersed in was very clear. Barbie was the antithesis of feminism. Emerging fresh in 2023 was a different view, fueled by a juggernaut marketing campaign that could be seen from space. Not seeing the movie makes me the worst critic, but I saw enough to know that Barbie was being remade. She was being crafted in the image of a new kind of feminism that represented a wholesale dumping of everything I thought I knew. The success of it all rang out the clearest truth, and it landed harder than the tangible scientific explanations I was uncovering about why kitchen cloths made me so angry. One of the biggest cultural phenomena of last year was not for me, and what I thought about it didn’t matter. I spent hours boring people about why elevating the movie into the feminist canon was wrong, and nobody gave a shit. Not giving a shit is a correct and justifiable response. Nobody needs to think as hard as I did about the Barbie movie. Nobody needs to spend months and months hating something they haven’t seen.  

In his My Generation essay, Justin H Smith writes: “It was around the time of that breakfast in Brussels that everything began to sink in for me, even if I still refused to see it. I was well into my forties, and dimly aware that there were by now a few billion people in the world leading full lives of their own, who would consider anything I had to say irrelevant simply by virtue of the fact that it was coming from an ‘old’ person.”

Age, with its sense of declining relevance, and hormonal change are inextricably linked, and yet confronting all of that at the same time feels like an accidental collision between trains running on different tracks. My breakfast in Brussels is the Barbie movie, and I hate it because I’m 44.  

The thing they don’t tell you about middle age is you are both at the midpoint of your own life, and you are the midpoint of the life all around you. You can mooch around as colloquially middle-aged for quite a while, but the midpoint is defined and fleeting. Once you’re past it, there is only over or under, above or below. No one can ever know the true midpoint of their life, and I might yet be far off it, but watching yourself drift further away from youth and the cultural power that has feels very real. I now understand why crisis and midlife go hand in hand. For the first time in my life, I feel like there might be more behind me, than in front. 

“The thing they don’t tell you” has become another popular refrain for me over the last year, most often used when I stumble upon the blindingly obvious. I have found a strange comfort in thinking about age and discovering those blindingly obvious things. It offsets the loss of agency felt when you’re suddenly angry about the kitchen cupboards and kitchen cloths and want to break a jug. The thing they do tell you is that it’s because you’re hormonal. The thing they don’t is that it’s because you’re 44.

‘If you value The Spinoff and the perspectives we share, support our work by donating today.’
Anna Rawhiti-Connell
— Senior writer